Mean Platelet Large Cell Ratio Research Articles

Correlation of Platelet Indices in Patients With Type 2 Diabetes Mellitus and Associated Microvascular Complications: A Hospital-Based, Prospective, Case-Control Study.

Background Diabetic patients exhibit increased platelet activity. Insulin inhibits the activation of platelets. Therefore, a relative or absolute deficiency of insulin would increase platelet reactivity. Theyounger (larger) platelets are also more metabolically and enzymatically active.If detected early, microvascular complications could alert us regarding the possible macrovascular complications.Thus, the aims and objectives of the present study were to determine platelet indices in patients with type 2 diabetes mellitus withcontrols (non-diabetics) and to find an association of platelet indices with microvascular complications. Material & methods In this prospective case-control study conducted from 2021 to 2022 (2 years), a total number of 200 subjects were taken and were divided into two groups of 100 each,cases (I) andcontrols (II). The cases included patients of diabetes mellitus (DM) ofa duration of more than 5 years, which were further divided into two groups of 50 each, IA and IB. Group IA consisted of patients with diabetes mellitus of a duration of more than five years with at least one microvascular complication and group IB wasdiabetics of more than five years duration without any microvascular complications, which includes diabetic retinopathy, diabetic nephropathy, and diabetic neuropathy. An automated cell counter (Thermo Fisher Scientific, Waltham, MA, US) provided hemoglobin values along with the platelet count and platelet indices, i.e. mean platelet volume (MPV), platelet large cell ratio (P-LCR), and platelet distribution width (PDW). Results The present study consisted of 200 subjects divided into 2 groups of 100 each, cases (I) andcontrols (II). The average MPV (9.4-12.3 femtolitre) in diabetics was 12.089±1.450 fLas compared to the controls where it was 9.464±1.424 fL with a statistically significant p-value of 0.001. PDWamong the cases was 16.868±2.352 fL while in controls, it was 12.753±10.559 fL (p=0.001). The mean P-LCR was 34.975±8.056% amongthe cases, in comparison to the mean P-LCR amongthe controls, which was 26.031±7.004 (p=0.001). In this study, the MPV, PDW, and P-LCR were significantly raised in individuals having diabetes with microvascular complications when compared with patients without complications. The mean MPV in diabetics with complications was 12.5960±0.95660 fL and in those without complications was 11.5820±1.67609 fL (with a p-value of P = 2×10-3)which is statistically significant. Similar results were obtained in cases of PDW and P-LCR. The mean PDW in diabetics with complications was 17.1140±2.58228 fL and without complications was 15.6220±2.10532 fL ((with a p-value of P = 2×10-3)). The mean P-LCR in diabetics with microvascular complications was 35.408±3.5490% and without complications was 33.542±4.8694% (with a p-value of P = 3.1×10-3). Conclusion Based on the findings of the present study, there is a statistical correlation between type 2 diabetes and variations in platelet indices, resulting in the associated microvascular complications. Higher MPV, PDW, and P-LCR values suggest that these parameters are more reliable predictors of early vascular complications in individuals with type 2 diabetes mellitus and can be utilized as an easy-to-use, low-cost method. They are a readily available, economical, practical, noninvasive, and simple-to-understand approach for assessing platelet dysfunction, which in turn helps anticipate the existence of microvascular complications.

Platelet large cell ratio (P-LCR) in predicting acute coronary syndromes before aspirin use

Introduction: Platelet large cell ratio (P-LCR) test is one of the test parameters that is routinely calculated in the hemogram test, and expressed as the ratio of platelets with platelet volume greater than 12 fL. Large platelets are relatively younger and contain more intracellular granules, meaning that platelets have more thrombogenic potential. In the literature investigating the relationship between the acute coronary syndrome and P-LCR levels, the use of aspirin in patients and its effects on platelet parameters were ignored. In our study, for the first time in the literature, the relationship between P-LCR levels and acute coronary syndromes were investigated by means of including the patients before they took aspirin which ensures that P-LCR test is not affected by aspirin. Method: Retrospectively, patients aged 18-70 years were screened and those whose hemogram tests were completed before aspirin usage were included. A total of 109 patients diagnosed with unstable angina (UA), non-ST elevation myocardial infarction (NSTEMI) and ST-elevation myocardial infarction (STEMI) were included and compared in the study. Results: The mean P-LCR values were 23.61% (95% CI: 21.97-25.25) in UA patients, 28.34% (95% CI: 24.86-31.83) in NSTEMI, and 25.71% (95% CI: 22.07-29.35) in STEMI patients. There was a statistically significant difference between the P-LCR values among the groups (p=0.022). Conclusion: The increase in P-LCR, free of aspirin effects, was found to be statistically significant in acute coronary syndromes.

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>11fl and PDW>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 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.

Evaluation of the diagnostic performance of platelet-derived indices for the differential diagnosis of thrombocytopenia in pediatrics

<p>Background. Platelet-derived indices have a well-established correlation with the differential diagnosis of thrombocytopenia in adult-based research. These indices include mean platelet volume, platelet distribution width, and platelet-large cell ratio.</p><p>Objective. To determine the values of platelet-derived indices in a pediatric population with diagnoses of thrombocytopenia and their etiologic correlation.</p><p>Materials and methods. Analytic observational diagnostictest study. The population for this analytical study was pediatric patients between 6 months and 18 years of age who had thrombocytopenia (<100x109/L). The study period was 18 months long.</p><p>Results. Of 54 subjects, 18 (33.3%) were diagnosed with idiopathic thrombocytopenic purpura, and 36 (66.7%) were diagnosed with acute leukemia. Mean age was 7.4 years and 6.8 years for immune thrombocytopenic purpura and acute leukemia, respectively. Mean platelet distribution width values for immune thrombocytopenic purpura and acute leukemia were 15.08 fL and 10.73, respectively. Mean MPV for immune thrombocytopenic purpura and acute leukemia was 11.7 fL and 9.8 fL, respectively. Mean platelet-large cell ratio was 38.26% and 24.97% for idiopathic thrombocytopenic purpura and acute leukemia, respectively. Differences in these three distinct platelet indices between idiopathic thrombocytopenic purpura and acute leukemia were statistically significant (p=0.00). The area under the ROC curve for platelet-derived indices showed that they were adequate for defining the causes of thrombocytopenia. MPV and platelet-large cell ratio had an area under the curve of 0.89 and 0.88, respectively, while platelet size deviation width had an area under the curve of 0.903.</p><p>Conclusions. Platelet-derived indices could be useful in the initial approach for the differential diagnosis of pediatric patients with thrombocytopenia.</p>