Mean platelet volume and response to the first line therapy in newly diagnosed adult immune thrombocytopenia patients: a retrospective study

Akkuş, Erman; Fidan, Çiğdem; Demirci, Gülşah; Kuştaş, Ali Aytuğ; Yüksel, Meltem Kurt

doi:10.3906/sag-1912-242

Cited by 5 publications

(4 citation statements)

References 18 publications

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“…A high MPV indicates high platelet production, and a low MPV indicates low platelet production [23,24]. A previous study revealed that newly diagnosed adult patients with primary ITP with high baseline MPV were more likely to respond to firstline treatment [12]. However, our results revealed that patients with a lower baseline MPV were more responsive to rhTPO treatment, inconsistent with the results of a previous study.…”

Section: Table 4 Outcomes In Rhtpo Groupcontrasting

confidence: 99%

“…Moreover, the clinical predictors associated with the therapeutic effects of rhTPO remain unclear. Studies have demonstrated a correlation of mean platelet volume (MPV) [12,13] and platelet-to-lymphocyte ratio (PLR) [14,15] with the efficacy of treatment in ITP patients. However, to our knowledge, no studies have investigated the relationship between these predictors and the therapeutic efficacy of rhTPO in pregnant patients with ITP.…”

Section: Introductionmentioning

confidence: 99%

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Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study

Lin,

Wang,

Huang

et al. 2023

BMC Pregnancy Childbirth

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Background Treatment options for pregnant women with immune thrombocytopenia (ITP) who do not respond to first-line treatment are limited. Few studies have reported the use of recombinant human thrombopoietin (rhTPO) for this subset of patients. Aims To investigate the efficacy and safety of rhTPO in ITP during pregnancy and determine obstetric outcomes and predictors of treatment response. Methods From July 2013 to October 2022, the data of 81 pregnant women with ITP and a platelet count < 30 × 109/L who did not respond to steroids and/or intravenous immunoglobulin were retrospectively analysed. Of these patients, 33 received rhTPO treatment (rhTPO group) while 48 did not (control group). Baseline characteristics, haematological disease outcomes before delivery, obstetric outcomes, and adverse events were compared between groups. In the rhTPO group, a generalised estimating equation (GEE) was used to investigate the factors influencing the response to rhTPO treatment. Results The baseline characteristics were comparable between both groups (P > 0.05, both). Compared with controls, rhTPO patients had higher platelet counts (median [interquartile range]: 42 [21.5–67.5] vs. 25 [19–29] × 109/L, P = 0.002), lower bleeding rate (6.1% vs. 25%, P = 0.027), and lower platelet transfusion rate before delivery (57.6% vs. 97.9%, P < 0.001). Gestational weeks of delivery (37.6 [37–38.4] vs 37.1 [37–37.2] weeks, P = 0.001) were longer in the rhTPO group than in the control group. The rates of caesarean section, postpartum haemorrhage, foetal or neonatal complications, and complication types in both groups were similar (all P > 0.05). No liver or renal function impairment or thrombosis cases were observed in the rhTPO group. GEE analysis revealed that the baseline mean platelet volume (MPV) (odds ratio [OR]: 0.522, P = 0.002) and platelet-to-lymphocyte ratio (PLR) (OR: 1.214, P = 0.025) were predictors of response to rhTPO treatment. Conclusion rhTPO may be an effective and safe treatment option for pregnancies with ITP that do not respond to first-line treatment; it may have slightly prolonged the gestational age of delivery. Patients with a low baseline MPV and high baseline PLR may be more responsive to rhTPO treatment. The present study serves as a foundation for future research.

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Section: Table 4 Outcomes In Rhtpo Groupcontrasting

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study

Lin,

Wang,

Huang

et al. 2023

BMC Pregnancy Childbirth

View full text Add to dashboard Cite

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“…Another literature study 18 showed that impaired megakaryopoiesis in aplastic anemia (AA) and acute leukemia (AL) with thrombocytopenia had no change in MPV levels and that MPV was higher in ITP patients than in AA and AL patients. The results of Akkuş et al 19 pointed out that MPV can be used as a predictor of early response to first-line treatment in newly diagnosed adult ITP patients. The above analysis shows that MPV and P-LCR% can be used as clinically valuable biological parameters for the diagnosis, differential diagnosis, and efficacy evaluation of ITP.…”

Section: Discussionmentioning

confidence: 99%

The Value of Combined Detection of Megakaryocyte and Platelet Parameters for the Diagnosis of Primary Immune Thrombocytopenia

Wang

Tao

Zhang

et al. 2022

Clin Appl Thromb Hemost

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Objective:To investigate the application value of bone marrow megakaryocyte count, the proportion of megakaryocytes at each stage, and the platelet parameter in the clinical diagnosis of primary immune thrombocytopenia (ITP). Methods: The megakaryocyte and platelet parameter level in 62 ITP and 40 control group patients were compared and analyzed. Linear correlation analysis, Pearson correlation analysis, and ROC curves were performed for the correlation between megakaryocytes and platelet parameters. Results: Compared to the control group, the total number of megakaryocytes, the promegakaryocytes the granular megakaryocytes (GMeg), and naked megakaryocytes (NMeg), MPV, and P-LCR% in the ITP group increased. All differences were statistically significant ( P<0.05). While the proportion of platelet-producing megakaryocytes (PMeg), PLT, and PCT decreased in the ITP group. These differences were statistically significant ( P < 0.05). PLT was strongly positively correlated with PCT (r = 0.921, p<0.01). PCT was weakly positively with MPV (r = 0.309, p<0.05). MPV was positively correlated with P-LCR (r = 0.856, p<0.01). PDW was weakly positively correlated with P-LCR (r = 0.296, p<0.05) and Meg (r = 0.301, p<0.05), and negatively correlated with PMeg (r = -0.336, p<0.05). ROC curve analysis showed that PLT, PCT MPV and P-LCR% gave a high sensitivity（100.0%，81.0%，74.6%，90.5%，respectively.) and specificity (100.0%, 92.5%, 80.0%, 77.5%, respectively.) in diagnosis of ITP. Conclusion: The combined analysis of bone marrow megakaryocyte count, the proportion of megakaryocyte classification at each stage, and platelet parameters have an important reference value for auxiliary diagnosis of ITP.

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“…In a study of 171 patients with thrombocytopenia, 4 out of 37 patients with ITP, the MPV was not elevated, though the highest values were found in ITP with a P value of less than 0.0001 [12]. The MPV in patients with ITP and healthy population was not very different ( P value 0.76) but high MPV had better outcome in patients with ITP [14]. The MPV cannot be measured accurately with very low platelet count as the analyzer may be unable to derive the MPV because of the platelet histogram distribution.…”

Section: Resultsmentioning

confidence: 92%

Primary immune thrombocytopenia: a ‘diagnosis of exclusion’?

Visweshwar

Ayala

Jaglal³

et al. 2022

Blood Coagulation &Amp; Fibrinolysis

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Current diagnosis of primary immune thrombocytopenia (ITP) is presumptive, centered on excluding other causes of thrombocytopenia. The diagnosis of ITP is challenging because of the wide range of potential inherited and acquired causes of thrombocytopenia. The treatment of ITP is empiric with steroids, high-dose immunoglobulin, immunosuppressants and thrombopoietin agonists with potential side effects. We searched Medline and Cochrane databases, reviewed the study data and analyzed the individual diagnostic tests for their evidence-based role in the diagnosis of ITP. We then analyzed the strength of the scientific evidence for each diagnostic test in the diagnosis of ITP and identified gaps in the diagnostic accuracy. The diagnostic challenges in ITP include: insufficient evidence for the individual test for diagnosis of ITP, no standardized protocol/guideline for diagnosis, hurdles in accessing the available resources and failure to correlate the clinical data while reviewing the blood smear. We did not identify a diagnostic test that clinicians can use to confirm the diagnosis of ITP. In the absence of a diagnostic test of proven value in ITP, the clinician is best served by a comprehensive history and physical examination, complete blood count and review of the peripheral blood smear in evaluating thrombocytopenia.

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Mean platelet volume and response to the first line therapy in newly diagnosed adult immune thrombocytopenia patients: a retrospective study

Cited by 5 publications

References 18 publications

Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study

Recombinant human thrombopoietin therapy for primary immune thrombocytopenia in pregnancy: a retrospective comparative cohort study

The Value of Combined Detection of Megakaryocyte and Platelet Parameters for the Diagnosis of Primary Immune Thrombocytopenia

Primary immune thrombocytopenia: a ‘diagnosis of exclusion’?

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