Increased Values of Mean Platelet Volume and Platelet Size Deviation Width May Provide a Safe Positive Diagnosis of Idiopathic Thrombocytopenic Purpura

Abstract

Introduction: It has been shown recently that platelet indices like mean platelet volume (MPV), platelet size deviation width (PDW) and platelet-to-large-cell ratio (P-LCR) are helpful in the discrimination between hyperdestructive thrombocytopenia like idiopathic thrombocytopenic purpura (ITP) and hypoproductive thrombocytopenia (HT). The aim of the study is to assess the reliability of these indices in the differentiation of ITP from other thrombocytopenias. Methods: We recruited 134 thrombocytopenic patients (69 men, 65 women) who were divided into two groups according to the underlying disease: group I (n = 63) included ITP patients, whereas group II (n = 71) included patients with HT due to myelosuppression secondary to chemotherapy for hematological malignancies. Platelet indices were derived from a Sysmex automated cell counter. Sensitivity, specificity, positive prognostic value, negative prognostic value, efficiency and Youden index were calculated. Results: Concerning MPV and PDW indices, sensitivity, specificity, positive prognostic value, negative prognostic value, efficiency and Youden index were 100% for the diagnosis of ITP. On the contrary, the values for P-LCR were significantly lower. Conclusions: MPV and PDW can be safely relied on for a positive diagnosis of ITP. MPV and PDW were superior to P-LCR.

Role of platelet indices in differentiating hypoproductive and hyperdestructive thrombocytopenia

“…In hyper destructive thrombocytopenia, bone marrow compensates actively for the platelet loss and start releasing young larger platelets ("left shift") which tend to decrease in size during its 7-10 days life span . [9] In our study also we found a significant low (10.17 ± 1.3) mean MPV in the hypoproduction group than in the hyperdestruction group (12.3 ± 0.9) Ntaios et al [10] found an increased MPV and PDW in Immune Thrombocytopenic Purpura (ITP). Kaito et al [2] similarly found a significant increase in MPV and PDW in ITP than in Aplastic anemia.Similarly few studies found a high PDW can also result in hyper destructive thrombocytopenia because of the release of heterogenous population of platelets which vary in their size (anisocytosis).…”

Neutrophil - Lymphocyte Ratio and Mean Platelet Volume Can Be a Predictor for the Severity of Acute Appendicitis

“…[17] MPV is actually a marker of functional status of platelets. It increases with production of young platelets; hence, MPV count indicates platelet activation.…”

The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia

“…If during the course of treatment or monitoring atypical features develop-for example, abnormalities in the white blood cell count, lymphadenopathy, multiple cytopenias-then the diagnosis of ITP should be reassessed. As in childhood ITP, we found insufficient evidence to recommend or suggest the routine use of antiplatelet, [61][62][63][64][65][66][67][68][69][70][71] antiphospholipid [72][73][74][75] and antinuclear antibodies, 13,76 thrombopoietin levels, 64,65,77 or platelet parameters obtained on automated analyzers 64,65,[78][79][80][81][82][83][84] in the evaluation of patients with suspected ITP.…”