Hypoproductive Thrombocytopenia Research Articles

The diagnostic accuracy of mean platelet volume in differentiating immune thrombocytopenic purpura from hypo-productive thrombocytopenia: A systematic review and meta-analysis.

Thrombocytopenia is defined as a decreased number of platelets in the circulating blood as a result of hypo-proliferation in marrow or peripheral destruction of platelets. Several diagnostic methods have been proposed to discriminate the underline cause of thrombocytopenia. Recent studies showed that mean platelet volume (MPV) could be used for differential diagnosis of immune thrombocytopenic purpura (ITP). Thus, we aimed to investigate the diagnostic accuracy of MPV for differential diagnosis of ITP from hypo-productive thrombocytopenia. This study was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA). The study protocol was registered on PROSPERO with the reference number CRD42023447789. Relevant published studies that were published up to April 10, 2023, in peer-reviewed journals were searched on electronic different databases. The methodological quality of the included studies was appraised using the quality assessment of diagnostic accuracy studies 2 (QADAS-2) tool. The pooled weight mean difference (WMD) of MPV between the ITP group and hypo-productive group was analyzed using a random-effects model meta-analysis. Relevant data were extracted using a Microsoft Excel spreadsheet and analyzed using STATA 11.0 and Meta-disc 1.4 software. Publication bias was evaluated using Deek's funnel plot asymmetry test. A total of 14 articles were included in this systematic review and meta-analysis. The comparison of MPV between groups revealed that the pooled mean value of MPV increased significantly in ITP patients compared to patients with hypo-productive thrombocytopenia (WMD = 2.03; 95% CI, 1.38-2.69). The pooled sensitivity and specificity of MPV in differentiating ITP from hypo-productive thrombocytopenia were 76.0% (95% CI: 71.0%, 80.0%) and 79.0% (95% CI: 75.0%, 83.0%), respectively. The summary positive likelihood ratio (PLR) and negative likelihood ratio (NLR)using the random effects model were 3.89 (95% CI: 2.49, 6.10) and 0.29 (95% CI: 0.18, 0.46), respectively. MPV can be used to discriminate ITP from hypo-productive thrombocytopenia. It can possess large advantages as it is noninvasive, simple, quick, inexpensive, easy to perform, reliable, and routinely generated by automated cell counters.

Neonatal Thrombocytopenia: Factors Associated With the Platelet Count Increment Following Platelet Transfusion

To understand better those factors relevant to the increment of rise in platelet count following a platelet transfusion among thrombocytopenic neonates. We reviewed all platelet transfusions over 6 years in our multi-neonatal intensive care unit system. For every platelet transfusion in 8 neonatal centers we recorded: (1) platelet count before and after transfusion; (2) time between completing the transfusion and follow-up count; (3) transfusion volume (mL/kg); (4) platelet storage time; (5) sex and age of platelet donor; (6) gestational age at birth and postnatal age at transfusion; and magnitude of rise as related to (7) pre-transfusion platelet count, (8) method of enhancing transfusion safety (irradiation vs pathogen reduction), (9) cause of thrombocytopenia, and (10) donor/recipient ABO group. We evaluated 1797 platelet transfusions administered to 605 neonates (median one/recipient, mean 3, and range 1-52). The increment was not associated with gestational age at birth, postnatal age at transfusion, or donor sex or age. The rise was marginally lower: (1) with consumptive vs hypoproductive thrombocytopenia (P<.001); (2) after pathogen reduction (P<.01); (3) after transfusing platelets with a longer storage time (P<.001); and (4) among group O neonates receiving platelets from non-group O donors (P<.001). Eighty-seven neonates had severe thrombocytopenia (<20000/μL). Among these infants, poor increments and death were associated with the cause of the thrombocytopenia. The magnitude of post-transfusion rise was unaffected by most variables we studied. However, the increment was lower in neonates with consumptive thrombocytopenia, after pathogen reduction, with longer platelet storage times, and when not ABO matched.

Diagnostic Accuracy of Immature Platelet Fraction (IPF) to Differentiate Between Thrombocytopenia due to Peripheral Destruction versus Bone Marrow Failure.

To analyse the predictive value of immature platelet fraction (IPF) as an independent diagnostic marker to differentiate between hyperdestructive and hypoproductive thrombocytopenia. Cross-sectional observational study. Place and Duration of the Study: Armed Forces Institute of Pathology Rawalpindi, from February to July 2022. A total of 164 samples were included in the study by non-probability consecutive sampling. Among these, 80 were obtained from normal individuals serving as control; 43 were obtained from patients having hyperdestructive thrombocytopenia (idiopathic thrombocytopenia, thrombotic thrombocytopenic purpura, disseminated intravascular coagulation); and 41 were obtained from those hypoproductive thrombocytopenia (acute leukaemia, aplastic anaemia, chemotherapy). Sysmex automated haematology analyzer, XN-3000 was used to determine the immature platelet fraction (IPF) of the patients. ROC curves analysis was done to ascertain area under curve. Immature platelet fraction (IPF %) was significantly higher in consumptive / hyperdestructive thrombocytopenia group i.e. median (IQR), 21% (14.4-26.2) as compared to 6.5% (4.6-8.9) in hypoproductive thrombocytopenia, and 2.6% (1.3-4.1) in normal control group (p <0.001). Cut-off value with the highest sensitivity and specificity for IPF vs. normal population was 7.95% with sensitivity of 97.7% and specificity of 86%. Immature platelet fraction (IPF of 7.95%) possesses high diagnostic accuracy, sensitivity and specificity for differentiation between hyperdestructive vs. hypoproductive thrombocytopenia. It can be used as a reliable marker to differentiate between the two entities. Immature platelet fraction, Thrombocytopenia, Bone marrow failure, Peripheral destruction.

DIAGNOSTIC ROLE OF PLATELET INDICES IN PATIENTS WITH THROMBOCYTOPENIA

Introduction: Thrombocytopenia is the most common cause of abnormal bleeding and can result from Hyper destruction of platelets, Hypoproduction of platelets and Abnormal platelet pooling. The aim of this study was to evaluate role of platelet indices (MPV, PDW, PCT) in diagnosing various causes of thrombocytopenia. In this observational analytic study 600 st Methodology: udy samples were divided into two groups: 300 cases diagnosed as thrombocytopenia (1.5 lakhs /microliter) and 300 healthy control. Cases of thrombocytopenia were further classied in 3 categories depending upon the predominant mechanism of thrombocytopenia. Statistical Analysis: Mean and SD of platelet count, mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) in each group was calculated and compared among groups using unpaired T- test. Out of 300 cases of Thrombocytopenia, Group A constituted 224 cas Results: es (75%) due to hyper destruction of platelets, Group B constituted 72 cases (24%) due to hypoproduction of platelets and Group C constituted 4 cases (1%) of Thrombocytopenia due to abnormal pooling of platelets. On comparing mean MPV and PDW values among groups, the MPV and PDW of hyper destructive thrombocytopenia was found to be higher than mean MPV and PDW of hypo productive thrombocytopenia as well as control group. The mean PCT of hyper destructive group was higher than that of hypo productive group. Combined interpretati Conclusion: on of platelet count and platelet indices are of signicant discriminating value in differentiating various causes of thrombocytopenia thus their standardized measures can signicantly increase its utility in diagnosis and understanding mechanism of various clinical condition

Особенности оказания трансфузиологической поддержки пациентам с гипопродукционной тромбоцитопенией в условиях дневного стационара ГБУЗ НСО «Новосибирский клинический центр крови»

Introduction. Hypoproductive thrombocytopenias caused by insufficient platelet formation in the bone marrow are usually a manifestation of the underlying process characterized by inhibition of thrombocytopoiesis. They accompany aplastic anemia, acute leukemia, primary myelofibrosis, myelodysplastic syndrome, may be the result of tumor metastasis to the bone marrow, with the substitution of the megakaryocyte lineage, as well as a complication of radiation therapy and chemotherapy. Aim. To analyze the features of the provision of transfusion support to patients with hypoproductive thrombocytopenia due to oncological or hematological diseases in the day hospital at the Novosibirsk Clinical Blood Center (NCBC). Materials and methods. The study included 222 patients of the NCBC day hospital who underwent replacement therapy with platelet concentrate to correct thrombocytopenia and hemorrhagic syndrome for the period 2017–2022. Results. Correction of thrombocytopenia due to malignant neoplasms (solid tumors) was performed in 69 patients and due to hematological diseases – in 153 patients. The average number of doses of platelet concentrate was 3.7 ± 2.4 for patients with solid tumors; the clinical efficacy of replacement therapy was achieved in this group of patients in all cases. For patients with hematologic-related thrombocytopenia, the average number of doses of platelet concentrate was 3.2 ± 1.3; the clinical efficacy in this group of patients was achieved in 131 cases out of 153. Conclusion. Replacement therapy with blood components in transfusion-dependent and comorbid patients in a day hospital allows in most cases (85.6%) to carry out effective clinical correction of thrombocytopenia and achieve complete reverse of manifestations of hemorrhagic syndrome (100% of cases).

Role of platelet volume indices in diagnostic approach of thrombocytopenia

Background: Platelet indices helps in the diagnosis of myriad cases of thrombocytopenia, the current study was conducted to underline their importance in the diagnosis of thrombocytopenia. Materials and Methods: A prospective cross sectional hospital based study was conducted in the CSSH, Meerut on blood samples received from both OPD and IPD patients from October 2019 to August 2021. A total of 200 cases of thrombocytopenia were studied. Detailed relevant clinical data was recorded including history, physical examination and available investigations including serological results. EDTA sample was run on five part hematology analyzers to collect various Platelet parameters. Results: Among all cases dengue was the main cases of thrombocytopenia. Majority of cases were of destructive thrombocytopenia and showed increased MPV and PDW as compared to hypoproductive thrombocytopenia. Conclusion: The evaluation of thrombocytopenic individuals is necessary in order to determine the cause and its implications for treatment. The interpretation of platelet indices can aid in the initial management of thrombocytopenic patients and avoid unnecessary invasive tests.

English

BACKGROUND Thrombocytopenia is defined as a low platelet count, less than 150000 / microlitre which is attributed to a variety of haematological and pathological disorders. It can result from four different mechanisms like hypoproduction, hyperdestruction, abnormal platelet distribution and dilutional loss. The type of mechanism leading to thrombocytopenia can be determined with the help of platelet count and platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (Pct). We wanted to study the utility of platelet count and platelet indices in the evaluation of thrombocytopenia, evaluate platelet indices as a diagnostic tool in differentiating various types of thrombocytopenia and correlate platelet indices with bone marrow findings. METHODS This was a prospective observational study done in a teaching medical college in India over a period of two years from June 2017 to May 2019. The patients were divided into two groups as hyperdestructive and hypoproductive related thrombocytopenia. The platelet count and platelet indices were determined in a five part haematology autoanalyzer and were compared with suitable controls. Findings were correlated with Bone marrow examination for exact aetiology RESULTS A total of 60 patients was considered for the study, of which 21 belonged to hyperdestructive thrombocytopenia and 39 belonged to hypoproductive group. All 21 cases in the former group were of immune mediated thrombocytopenia (ITP). MPV 11.51 ± 1.97 was significantly higher in hyperdestructive thrombocytopenia as compared to hypoproductive thrombocytopenia wherein it was 8.34 ± 2. PDW was also more in the former group as compared to latter and showed a mean value of 16.67 ± 1.03 and 14.68 ± 2.29 respectively. The difference in Pct was insignificant in determining the cause of thrombocytopenia between the groups. CONCLUSIONS Platelet indices give valuable preliminary information as to the type of thrombocytopenia, i.e. hyperdestructive or hypoproductive type. This will guide in patient management decisions and may obviate the need for bone marrow examination in at least some patients. Also platelet indices do not need extra blood sample and do not incur additional cost. KEYWORDS Hyperdestructive, Hypoproductive Thrombocytopenia, Platelet Indices, Bone Marrow, ITP

Predictive Value Of Platelet Indices For Differentiating Hyper Destructive Thrombocytopenia From Hypo Productive Thrombocytopenia In Patients Attending Teritiary Care Hospital

BACKGROUND: Thrombocytopenia is one of the most critical and complicated clinical conditions to manage. Hence the need for a platelet count has increased over the years in the form of manual smear count and bone marrow examination for discriminating hyper destructive and hypo productive thrombocytopenia. The introduction of platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), Platelet large cell ratio (PLCR) in automated haematology analyzers has provided a window into the cause of thrombocytopenia in the recent years. Hence this study was undertaken to analyze the utility of these platelet indices in hypo productive and hyper destructive thrombocytopenia. METHODS: A prospective cross-sectional study was conducted on 84 thrombocytopenic patients out of which 49 were hyper destructive and 35 were hypo productive group. The blood samples were analyzed for CBC diff using SYSMEX XN 1000. Statistical analysis was performed to assess the mean SD, Receiver Operating Curve (ROC) to determine the specificity, sensitivity, positive predictive value (PPV) and negative predictive values (NPV) for platelet parameters. Correlation test to determine association between the continuous variables was done. RESULT: All platelet indices were significantly higher in hyper destructive than in hypo productive group. The MPV and PLCR showed better sensitivity and specificity, positive and negative predictive values when compared to PDW in both the groups. There was statistically significant correlation and difference of platelet parameters like MPV, PDW and PLCR between the hyper destructive and hypo productive thrombocytopenia. CONCLUSION: The platelet indices MPV and PLCR have better ability to discriminate hyper destructive from hypo productive thrombocytopenia. Evaluating these parameters offers an earlier diagnosis in hyper destructive thrombocytopenia patients avoiding, bone marrow aspiration and even prevent undesirable platelet transfusion.

Diagnostic Implication of Mean Platelet Volume in Thrombocytopenia

Introduction: The newer haematology analysers measure the platelet indices such as the mean platelet volume (MPV), platelet large cell ratio and platelet distribution width. It has been observed that MPV is increased in conditions associated with thrombocytopenia due to peripheral destruction. This study was carried out to know the utility of MPV and derive cut-off values in categorizing the conditions causing thrombocytopenia into hyperdestructive and hypoproliferative groups. Methods: The thrombocytopenia cases were categorized into two groups as hyperdestructive and hypoproliferative groups based on the bone marrow findings. The MPV on the day of admission was taken into consideration. The data were analysed using the mean, standard deviation and the t-test. ROC curve was plotted to derive the cut-off MPV value. Results: Of the total 89 thrombocytopenia cases, 53 were of hyperdestructive etiology and 36 were of hypoproliferative etiology. The mean MPV for group A was 9.56 with a standard deviation of 1.34 and that for group B was 8.45 with a standard deviation of 1.30. The p value was < 0.001. From the ROC curve, a cut off of 8.5 fl was taken. Conclusion: We conclude that a MPV value of >8.5fl is suggestive of a hyperdestructive etiology. Even though bone marrow remains a gold standard to distinguish between the hyperdestructive and hypoproductive thrombocytopenia groups, platelet indices like MPV can be used to aid in the diagnosis of etiology of thrombocytopenia.

Role of mean platelet volume (MPV), platlet distribution width (PDW) and platelet large cell ratio (PLCR) in diagnosis of hyperdestructive thrombocytopenia.

Thrombocytopenia has been shown to have significant mortality if ignored. Platelet indices have been reported to be useful prognostic indicators. The objectives of this study was to determine the diagnostic importance of the platelet indices in diagnosis of hyperdestructive thrombocytopenia i.e ITP. Study Design: Cross sectional observational study. Setting: Department of Pathology (MTI) Qazi Hussain Ahmed Medical Comeplex Nowshera Medical College. Period: Aug 2017 to Jan 2018. Materials and Methods: These blood samples were analyzed in clinical Pathology laboratory of QHAMC. Required information’s were recorded on predesigned proforrma as per objectives of the study. Results: The peripheral smears of 139 cases were reported in the study. Detailed history and Thorough clinical examination was conducted. Mean age of the study population of the patients with standard deviation was 30.90(±6.4) years. Mean platelet count was 27. 37(±12.8) x109/. Mean platelet volume MPV was 11.4(±1.4) fl. Mean platelet distribution width (PDW) was 15.4(±3.3) fl. Mean platelet large cell ratio (PLCR) was 39.6(±8.9) %. Eight cases with MPV lower than 11fl and cases with PDW more than 15fl that were also having pancytopenia or bycytopenic picture were advised bone marrow aspiration for further diagnosis if clinically indicated. Six cases out of eight to whom bone marrow was advised were sent for bone marrow examination by the clinicians and we found that three of them were idiopathic thrombocytopenia and one Megaloblastic anemia, one case with pancytopenia due to hyperspleenism and one with acute leukemia with eosinophilia. Conclusion: From the above we concluded that all cases with MPV&gt;11fl and PDW&gt;14fl are sensitive and specific indicators for ITP and These indices help to distinguish hyper-destructive thrombocytopenia and hypo-productive thrombocytopenia very easily and it is also cost effective on a very simple test that is special smear. We must look for platelet indices very keenly while reporting a case with bi-cytopenia and pancytopenia.

Role of platelet parameters in thrombocytopenia

Introduction: Modern day analyzers are generating a number of parameters which with time have gained a lot of clinical significance. The platelet indices have been investigated as prospective platelet activation markers. The aim of this study is to predict the relationship between platelet parameters and cause of thrombocytopenia and their role in predicting prognosis in dengue. Method: It is an observational study conducted at SAKRA World Hospital. The patient’s data, platelet count, MPV and PDW were recorded using standard proforma.Results: The study was conducted on 263 cases of thrombocytopenia that were broadly categorized into three groups- Group A with accelerated platelet destruction, Group B with impaired production and Group C with abnormal pooling. The platelet indices were compared in the three categories. Relationship between the platelet indices were made with severity of thrombocytopenia. Significant relationship was observed between severity of the thrombocytopenia and severity of the disease.Conclusion: Platelet indices can be used as reliable indicators in differentiating hyperdestructive and hypoproductive thrombocytopenia. They also serve as prognostic markers in indicating the severity of disease in dengue patients. Low MPV (13fl) in dengue patients predicted prognosis to severe thrombocytopenia.

Role of Platelet Indices and Antiplatelet Antibody in Differentiating Immune Thrombocytopenic Purpura from Other Causes of Thrombocytopenia

Background: thrombocytopenia may be defined as a decrease in number of platelets in the circulating blood. Bone marrow examination may be required to discriminate causes of thrombocytopenia as hypoproductive or hyperdestructive. However, this procedure is invasive and time consuming. Objective: this study aims to assess the diagnostic value of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell-ratio (P-LCR) and anti-platelet antibody in discriminating causes of thrombocytopenia as hypoproductive or hyperdestructive immune thrombocytopenia purpura (ITP). Patients and Methods: the study was conducted on 45 subjects15 patients suffering from ITP, 15 patients suffering from other causes of thrombocytopenia, and 15 healthy controls. All of them were subjected to full clinical history, examination and routine investigation including CBC, routine chemical analysis (liver function, renal function, etc.), BM aspirate and detection of antiplatelet antibody. Results: the results of this study revealed that in ITP patient group, we found that the MPV, PDW and P-LCR were significantly higher in comparison to non-ITP group. As regard anti-platelet antibody detection by ELISA method was positive (60%) in ITP group, positive (26.7) in nonITP group and negative in all patients in control group. It revealed no significant difference between ITP group and non-ITP group to diagnose ITP. Conclusion: from this study, we could conclude that, measuring of platelet indices (MPV, PDW and LCR) provides useful diagnostic test in differentiating ITP from hypoproductive thrombocytopenia, thus may avoid the need for bone marrow examination. Measurement of anti-platelet antibody is not a reliable test in diagnosis of ITP.

Immature Platelet Fraction: A Useful Marker for Identifying the Cause of Thrombocytopenia and Predicting Platelet Recovery

Introduction: The assessment of thrombopoietic activity in bone marrow is necessary for patients with thrombocytopenia to achieve correct diagnoses and effective treatments. We evaluated the discriminatory power of the immature platelet fraction (IPF%) in differentiating hyperdestructive/consumptive thrombocytopenia from hypoproductive thrombocytopenia, and its potential use as a predictive marker for platelet recovery.Methods: Platelet indices including IPF% were measured in 105 healthy individuals (the control group), 31 patients with hyperdestructive/consumptive thrombocytopenia (14 with immune thrombocytopenic purpura [ITP] and 17 with liver cirrhosis), and 34 patients with hypoproductive thrombocytopenia (4 with aplastic anemia and 30 with cancer who were undergoing chemotherapy) by using a Sysmex XN-3000 hematology analyzer.Results: The platelet number in the hyperdestructive/consumptive thrombocytopenia group was significantly lower than that in the hypoproductive thrombocytopenia group (P <0.001). The difference of plateletcrit (PCT) between the 2 thrombocytopenia groups was not statistically significant (P= 0.363). The IPF% was significantly higher in the hyperdestructive/consumptive thrombocytopenia group (median: 6.2% [IQR 4.3-10.3%]) than in both the control group (1.8% [1.3-2.4%]) and the hypoproductive thrombocytopenia group (1.8% [0.9-2.3%]) (all P-values < 0.001). However, the difference between the hypoproductive thrombocytopenia and control groups was not statistically significant (P= 0.331). Compared to the control group, the hyperdestructive/consumptive thrombocytopenia group showed a 190.5% increase in the median IPF% value, while the hypoproductive thrombocytopenia group showed a 9.5% decrease. The IPF# was significantly different between the 3groups; it was highest in the control group (median: 4.3 ×109/L [IQR 3.5-5.8×109/L]), followed by the hyperdestructive/consumptive thrombocytopenia group (3.2×109/L [1.7-4.5×109/L]), and lowest in the hypoproductive thrombocytopenia group (1.3 ×109/L [0.7-2.0×109/L]) (all P-values <0.001). Compared to the control group, the hyperdestructive/consumptive thrombocytopenia group showed a 25.6% decrease and the hypoproductive thrombocytopenia group a 69.8% decrease. PDW, MPV, and P-LCR were higher in the hyperdestructive/consumptive thrombocytopenia group (14.5 ± 3.0 fL, 12.0 fL [IQR: 11.0-12.0 fL], and 38.9 ± 6.8%, respectively) than in the other 2 groups, but there was no statistical difference between the other 2 groups. The IPF% in the hyperdestructive/consumptive group increased significantly as the number of platelets decreased, especially in patients with severe thrombocytopenia with platelet counts under 40.0 ×109/L. The IPF% was 4.7% (3.1-4.7%), 6.2% (3.2-7.6%), and 11.4% (7.1-16.6%) in patients with platelet counts>90.0 ×109/L, 40.0-90.0 ×109/L and<40.0 ×109/L, respectively (P = 0.010). However, this phenomenon was not observed in the hypoproductive thrombocytopenia group. The area under the curve (AUC) was highest for IPF% (0.938), indicating that this parameter showed the best discriminatory ability between the 2 groups, followed by PDW (0.885), P-LCR (0.859), IPF# (0.827), and MPV (0.824) (all P-values <0.001). The best IPF% cut-off value indicative of the highest sensitivity and specificity was 2.3%. The AUC of PCT was under 0.5 (0.445, P = 0.477), showing no discriminatory power. The IPF% decreased 3-4 days in advance of platelet count elevation in patients with ITP, while the IPF# ratio (compared to baseline) increased 3 days in advance of the same. Furthermore, the IPF% and IPF# ratio increased 5.5 days and 8.5 days, respectively, before platelet counts increased up to 130.0 × 109/L in cancer patients receiving chemotherapy.Conclusion: IPF% showed the most % value difference between the 3 groups and the largest AUC, showing it has the best discriminatory power in distinguishing the cause of thrombocytopenia. Also, IPF% showed an inverse correlation with platelet count in the hyperdestructive/consumptive thrombocytopenia group, but not in the hypoproductive thrombocytopenia group. The IPF% and IPF# were useful markers to predict the elevation of platelet count in advance in ITP and in cancer patients receiving chemotherapy. DisclosuresNo relevant conflicts of interest to declare.

Diagnostics of thrombocytopenias

Laboratory methods used for the diagnostics of thrombocytopenias are reviewed. Differential diagnosis is usually carried out between immune and hypoproductive forms of thrombocytopenia. Immune thrombocytopenias are caused by appearance in blood of antiplatelet abtibodies and accelerated destruction of platelets sensibilized by those antibodies, and hypoproductive thrombocytopenias - by impaired platelet production in the bone marrow. Main directions of the laboratory diagnostics of thrombocytopenias - analysis of auto- and alloautoantibodies and evaluation of platelet production and turnover in the blood stream. The following methods are used for the investigation of antiplatelet antibodies: 1) measurement of platelet associated immunoglobulins; 2) determination of circulating antibodies reacting with platelets; 3) determination of antibodies using antigen specific methods - by their reactivity with isolated platelet antigens (glycoproteins). Efficacy of platelet production could be assessed by measuring in blood the amount of "young" (reticulated) platelets. One more method for the evaluation of platelet production as well as the rate of platelet turnover - measurement of plasma soluble glycocalicin, glycoprotein Ib fragment shed from the surface of platelets upon their destruction in spleen and liver. In patients with immune thrombocytopenia autoantibodies are evaluated in all cases, the percentage of reticulated platelets is significantly increased and the amount of plasma glycocalicin is within the normal range or increased. In patients with hypoproductive thrombocytopenia autoantibodies are not detected or detected at low level, the percentage of reticulated platelets is within the normal range or slightly increased and the amount of plasma glycocalicin is lowered. Diagnostics of hapten forms of immune thromocytopenias (heparin-induced thrombocytopenia and others) and of alloimmune thrombocytopenias (neonatal alloimmune thrombocytopenia in particular) are considered in the separate sections of this review.

Platelet indices as a diagnostic tool in pediatric immune thrombocytopenic purpura

Background Bone marrow examination is the gold-standard test in discriminating between hyperdestructive thrombocytopenia and hypoproductive thrombocytopenia. However, this procedure is invasive. Mean platelet volume (MPV) and platelet distribution width (PDW) are simple, inexpensive, and noninvasive methods that may be used in discriminating between these two types of thrombocytopenia. Aim This study investigated the significance of the platelet indices, MPV and PDW, in the diagnosis of immune thrombocytopenic purpura (ITP). Patients and methods The study population were divided into three groups: 15 patients with hyperdestructive thrombocytopenia and 15 with hypoproductive thrombocytopenia were compared with control group (15 healthy controls). The sensitivity and specificity of these platelet indices to diagnose immune thrombocytopenic purpura were also measured. Results The MPV showed a sensitivity of 93.3% and a specificity of 66.7% at a cutoff value of 7.7 fl, and the PDW showed a sensitivity of 86.7% and specificity of 73.3% at a cutoff value of 40.6%. Conclusion The study concluded that although MPV and PDW can be used as an initial hint for predicting the type of thrombocytopenia, they have limited sensitivity and specificity.

Use of Platelet Indices in the Differential Diagnosis of Hypo-Productive and Hyperproductive Thrombocytopenia in Children

Use of Platelet Indices in the Differential Diagnosis of Hypo-Productive and Hyperproductive Thrombocytopenia in Children

Diagnostic predictive value of platelet indices for discriminating hypo productive versus immune thrombocytopenia purpura in patients attending a tertiary care teaching hospital in Addis Ababa, Ethiopia.

BackgroundBone marrow examination may be required to discriminate causes of thrombocytopenia as hypoproductive or hyperdestructive. However, this procedure is invasive and time consuming. This study assessed the diagnostic value of Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Platelet Large Cell-Ratio (P-LCR) in discriminating causes of thrombocytopenia as hypoproductive or hyperdestructive (Immune thrombocytopenia purpura).MethodA prospective cross-sectional study was conducted on 83 thrombocytopenic patients (Plt < 150 × 109/L). From these, 50 patients had hypoproductive and the rest 33 Immune Thrombocytopenia Purpura (ITP). Age and sex matched 42 healthy controls were included as a comparative group. Hematological analysis was carried out using Sysmex XT 2000i 5 part diff analyzer. SPSS Version16 was used for data analysis. A two by two table and receiver operating characteristic (ROC) curve was used to calculate sensitivity, specificity, positive and negative predictive values, for a given platelet indices (MPV, PDW and P-LCR). Student t test and Mann Whitney U test were used to compare means and medians, respectively. Correlation test was used to determine associations between continuous variables.ResultsAll Platelet indices were significantly higher in ITP patients (n = 33) than in hypoproductive thrombocytopenic patients (n = 50) (p < 0.0001). In particular MPV and P-LCR have larger area under ROC curve (0.876 and 0.816, respectively), indicating a better predictive capacity, sensitivity and specificity in discriminating the two causes of thrombocytopenia. The indices were still significantly higher in ITP patients compared to 42 healthy controls (p < 0.0001). A significant negative correlation was observed between platelet count and platelet indices in ITP patients, (p < 0.001).ConclusionMPV, PDW and P-LCR help in predicting thrombocytopenic patients as having ITP or hypoproductive thrombocytopenia. If these indices are used in line with other laboratory and clinical information, they may help in delaying/ avoiding unnecessary bone marrow aspiration in ITP patients or supplement a request for bone morrow aspiration or biopsy in hypoproductive thrombocytopenic patients.

Platelet Distribution Width (PDW) - A Rarely Studied Platelet Indice for Determining the Causes of Thrombocytopenia

Background: Thrombocytopenia (TCP) is low platelets count, which is either due to defective platelet production or due to increased platelet breakdown. The platelet number alone does not give a complete picture of platelet maturity and function, therefore, the platelet indices have been the subject of intensive study in recent years, but they have not been firmly established. Mean platelet volume (MPV) and platelet distribution width (PDW) are useful parameters in evaluating disorders of platelets. This study was undertaken to evaluate the effectiveness of PDW in diagnosing causes of thrombocytopenia. Methods: 510 cases of thrombocytopenia and 500 cases of Control group with normal platelet count were included in the study. TCP was defined as platelet counts below 1.5 lacs/cumm. Hematological analysis was done on Mindray BC-3000 plus automated hematology analyzer. All cases were reevaluated by peripheral smear examination. Only those cases were included in the study, which showed platelet count and platelet volume parameters with graph both in cases and in control group. Results: Hyper-destructive group constituted majority of the cases 352 (69%), while hypo-productive group and abnormal pooling constituted 30% and 1.42% cases respectively. The mean PDW was significantly higher in hyper-destructive group when compared with hypo-productive group, Abnormal pooling and control group. The difference was statistically significant. Conclusion: PDW provides plenty of clinical information about the causes and patho-mechanisms of thrombocytopenia and could be helpful to distinguish hyper-destructive thrombocytopenia from hypo-productive thrombocytopenia. More attention should be paid to PDW along with other platelet indices to differentiate between hyper-destructive TCP from hypo-productive and abnormal pooling TCP.

Role of Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Platelet Large Cell Ratio (P-LCR) Value in the Diagnosis of Immune Thrombocytopenic Purpura

A cross-sectional retrospective study was carried out at the Bangabandhu Sheikh Mujib Medical University, Dhaka to determine the diagnostic significance of platelet indices in ITP. Total 60 cases were included in this study. Complete history was taken either from patient or accompanying attendants. Thorough clinical examination was done. Mean age of the study population of aplastic anaemia (AA) was 36.66(±17.04) years and immune thrombocytopenic purpura (ITP) was 29.70(±13.99) years. Mean platelet count was 38.73(±15.99) x109/L and 30.46(±14.17) x109/L in AA and ITP respectively and that was not statistically significant. In AA mean platelet volume was 9.75(±1.15) fl and in ITP mean platelet volume was 12.01(±1.23) fl. In AA mean platelet distribution width was 11.75(±2.13) fl and in ITP mean platelet distribution width was 18.07(±2.52) fl. In AA mean platelet large cell ratio was 21.07(±5.51) % and in ITP mean platelet large cell ratio was 36.68(±7.91) % and that was statistically significant. Sensitivity and specificity of platelet indices to make a diagnosis of ITP was calculated under various cut-off ranges. MPV cut of value >11fl sensitivity was 73.33% and Specificity was 80.0%, MPV cut of value >12 fl sensitivity was 53.3% and Specificity was 96.7%, MPV cut of value >13 fl sensitivity was 26.7% and Specificity was 100%. PDW cut of value >14 fl sensitivity was 86.67% and Specificity was 93.3%. PDW cut of value >15 fl sensitivity was 100% and Specificity was 83.0%. P-LCR cut of value >40% sensitivity was 100% and Specificity was 63.0%. These indices could help to distinguish hyper-destructive thrombocytopenia and hypo-productive thrombocytopenia very easily and it is also cost effective. Platelet indices, if reported, provide a lot of clinical information about the underlying conditions of thrombocytopenia.

Relationships of Mean Platelet Volume and Plasma Thrombopoietin with Glycocalicin Levels in Thrombocytopenic Patients

Backgrounds/Aims: Relationships of mean platelet volume (MPV) and thrombopoietin (TPO) with platelet turnover assessed by glycocalicin measurement were evaluated in thrombocytopenic patients. Methods: MPV, glycocalicin and platelet-associated IgG (PA-IgG) were measured in 107 patients with idiopathic thrombocytopenic purpura (ITP) and 19 patients with hypoproductive thrombocytopenia (HPT; aplastic anemia or leukemia), and TPO was measured in 53 ITP and 12 HPT patients. All the included ITP patients had PA-IgG ≥300% and glycocalicin ≥50% of control values, and HPT patients had PA-IgG <300% and glycocalicin <50% of control values. Results and Conclusions: MPV was higher in ITP than in HPT patients: 9.56 ± 1.69 and 7.59 ± 0.90 fl (p < 0.001). In the ITP group a direct correlation was detected between MPV and glycocalicin (r = 0.344, p < 0.001). This interaction was essentially expressed in patients with normal/increased glycocalicin (≥100% of control; r = 0.470, p < 0.001, n = 64). TPO was greatly enhanced in HPT in comparison with ITP patients (958 ± 659 and 11 ± 27 pg/ml, p < 0.001). In the ITP group a reverse correlation was detected between TPO and glycocalicin (r = -0.373, p = 0.006). © 2014 S. Karger AG, Basel