Evaluation of the Immature Reticulocyte Fraction (IRF) and Immature Platelet Fraction (IPF) for Differentiation of Fever Symptoms in Patients with Dengue Fever and with Influenza
Keywords:
Immature reticulocyte fraction (IRF) , Immature platelet fraction (IPF), Dengue feverAbstract
Dengue fever is caused by dengue virus, transmitted by female mosquitoes. One of the pathological mechanisms following viral infection is bone marrow suppression, which perturbs erythropoiesis and thrombopoiesis. The immature reticulocyte fraction (IRF) and the immature platelet fraction (IPF) indicate the functions of bone marrow. IRF is commonly used to monitor bone marrow transplantation patients and anemic individuals, while IPF can be used to evaluate platelet recovery following platelet transfusion. In this study, collective data from 122 subjects aged between 18-34 years old were divided into control, influenza, and dengue fever groups. Moreover, patients with dengue fever were categorized into the febrile, critical and recovery phases. General characteristics such as age, body temperature, blood pressure and pulse as well as all complete blood count (CBC) parameters were collected and statistically analyzed. The average IRF and IPF of control, influenza and dengue fever groups were 9.65%, 8.33%, 11.87% and 1.77%, 2.46%, 4.82%, respectively. There were significant differences among these three groups for IPF values (p < 0.001), but not for IRF values. For dengue fever with febrile, critical and recovery phases, the averages IRF were 10.96%, 10.66% and 13.99% and the average IPF were 3.01%, 7.95% and 3.50%, respectively. There were significant differences among the three groups for IPF values (p = 0.001), but not for IRF values. For comparison of IRF and IPF values in patients with fever (≥ 37.5°C), IRF was not significantly different (p = 0.970) between influenza and dengue fever groups whereas IPF in dengue fever group (5.48%) was significantly higher than that of the influenza group (2.46%) (p < 0.001). To evaluate the efficiency of IPF, ROC curve analysis was used, and the results showed that the AUC of the IPF was 0.777 (95% CI 0.668-0.886). At the cut-off value of 2.15%, the sensitivity and specificity of IPF were 85.7% and 50.0%, respectively. These suggest that IPF can be used in combination with other parameters along with patient symptoms for screening dengue fever from influenza for early diagnosis and optimal treatment.
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