Dear Doctors, There is a sudden spurt in the dengue cases last few days. We are seeing increasing patients with very low platelets like 20, 000 or so. Such patients need urgent admission and aggressive management to prevent dengue hemorrhagic fever, dengue shock. In the context of thrombocytopenia I wish to talk about a test call IPF. This stands for immature platelet fraction. It is a marker of thrombopesis which quantitates reticulated platelets that are newly released into the circulation from the marrow. It's normal value ranges from 1.1 to 6. If values are above 8, it indicates an excellent marrow response and predicts an increase in platelets in next 48 hours. If values are low it indicates a poor bone marrow response. In such patients like dengue fever IPF value helps us to predict when the platelets will rise. In pregnancy it also helps to differentiate HELLP syndrome from HUS/TTP. Other platelet indices which are helpful markers of thrombopesis are as follows: Mean platelet volume (MPV) Platelet distribution width (PDW) Platelet to large cell ratio (PLCR) All three are elevated indicating good thrombopoesis. Dr Hardik Thakker MD MED, ECFMG (USA).