Platelet Size Deviation Width Research Articles

A STUDY OF PLATELET VOLUME PARAMETERS IN THROMBOCYTOPENIA CASES.

Recent studies showed that platelet parameters such as mean platelet volume (MPV), plateletcrit (PCT), platelet size deviation width (PDW) could be used for differential diagnosis of thrombocytopenia. In the present study, accordingly, we aimed to investigate the signicance of these parameters in the differential diagnosis of thrombocytopenia. One hundred sixty-four (164) patients with thrombocytopenia were included in the present study. The patients were divided into two groups according to the time of the diagnosis of thrombocytopenia: hyperdestructive (75 ITP) and hypoproductive (25 AA, 25 MDS, 24 AML, 15 ALL). The diagnosis was made based on hematological, pathological, and chromosomal analyses and guidelines. Samples for complete blood counts were collected in K3EDTA tubes and analyzed with an automated hematology analyzer, Beckman-Coulter. The platelet count was similar in both groups. The present results showed that there were no statistically signicant differences between the groups in terms of age, gender and PDW. However, MPV was signicantly higher in the hyperdestructive group than the hypoproductive group. By contrast, PCT was considerably lower in the hyperdestructive group than the hypoproductive group The results of the present study indicated that these platelet parameters might provide additional contributions to strengthen the diagnosis in patients diagnosed with ITPand would be benecial to consider the thrombocyte parameters as well as the clinical and other laboratory tests of the patient

Thrombocyte indices and plateletcrit in dogs with primary immune-mediated hemolytic anemia

Primary immune-mediated hemolytic anemia (IMHA) is one of the most common autoimmune disorders in dogs. Platelet indices in dogs with IMHA have not been commonly used in daily clinical practice. The purpose of this study was to evaluate trombocyte indices, including platelet count (PLT), mean platelet volume (MPW), platelet size deviation width (PDW), and plateletcrit (PCT) in dogs with primary IMHA and to compare them with the corresponding values in a control series of healthy dogs. This study was performed on 21 dogs diagnosed with primary IMHA and 11 healthy dogs. The inclusion criteria were the presence of a positive Coombs’ test, true agglutination, anemia with HCT <35 %, hyperbilirubinemia, bilirubinuria, hemoglobinemia, hemoglobinuria, and spherocytosis. MPV and PDW were significantly higher in the dogs with IMHA compared to the reference population. No significant differences were found in PLT and PCT between the groups. The use of MPV and PDW values in evaluating the bone marrow response would be helpful in dogs with primary IMHA.

Use of the Platelet Indices for Differential Diagnosis of Pediatric Immune Thrombocytopenic Purpura ( ITP )

IntroductionThe prognosis of pediatric immune thrombocytopenic purpura (ITP) has a favorable prognosis, but it is difficult to predict the course of this disease at the time of diagnosis. Recent advances of automated blood cell analyzer enable to measure platelet indices such as mean platelet volume (MPV), platelet size deviation width (PDW) and platelet-large cell ratio (P-LCR). These have brought about some information for thrombocytopenia. We studied the significance of such platelet indices in the differential diagnosis of immune thrombocytopenic purpura (ITP) and their ability to discriminate the clinical courses of ITP.MethodsNinety-three patients were enrolled this study at our institution from 2004 to 2006. Their ages ranged from 1 to 17 years (media 4.3 years). Of 93, patients were divided into two goups for analysis, according to the diagnosis of ITP. 34 were diagnosed as ITP and 59 were diagnosed various blood diseases other than ITP. In these 59 non-ITP patients, five were with thrombocytopenia (platelet count < 100.0 x 109/L), the other without thrombocytopenia. Of 34 ITP patients, 29 were acute subtype and 5 were chronic. The Sysmex-XE2100 automated blood cell analyzer (Sysmex, Kobe, Japan) was used to measure the blood parameters, including the platelet indices.ResultsAccording to MPV, PDW and P-LCR, there were no significant differences between ITP patients and non-ITP. In children with ITP, there were significant inverse correlations between the platelet count and evaluated parameters, MPV (R2=0.376), PDW (R2=0.26) and P-LCR(R2=0.338). But no significant correlations were found between the platelet count and these evaluated platelet indices in non-ITP. Also, we have found all platelet indices were significantly higher in chronic ITP than in acute ITP. In particular, PDW (9.910 vs 13.080) and P-LCR (21.071 vs 33.220) showed marked differences between the two groups.ConclusionsITP is considered as a result of hyper-destruction of platelets. Increase of platelet count is regarded as decrease of destruction of platelets. Our data suggested that platelet indices, MPV, PDW and P-LCR showed the useful information for the degree of platelet destruction and the ability to predict the clinical courses of ITP. DisclosuresNo relevant conflicts of interest to declare.

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

&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Objective. To determine the values of platelet-derived indices in a pediatric population with diagnoses of thrombocytopenia and their etiologic correlation.&lt;/p&gt;&lt;p&gt;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 (&amp;lt;100x109/L). The study period was 18 months long.&lt;/p&gt;&lt;p&gt;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.&lt;/p&gt;&lt;p&gt;Conclusions. Platelet-derived indices could be useful in the initial approach for the differential diagnosis of pediatric patients with thrombocytopenia.&lt;/p&gt;

Platelet size deviation width measured at hospital admission predicts in-hospital mortality and all cause mortality at follow up after discharge in acute pulmonary embolism

Introduction: Platelet distribution width (PDW) directly measures the variability in platelet size and it has been postulated that large platelets may be an indi- cator of platelet activation. No data has been reported so far about the impact of this index on prognosis of acute pulmonary embolism (APE). Thus, the aim of this study was to assess the impact of PDW measured at hospital admission on both in-hospital and after discharge prognosis in patients with APE diagnosed by multislice computed tomography (MSCT). Methods and population: Retrospective, observational study that included all patients with APE diagnosed by MSCT during emergency room (ER) stay in the year of 2010. Blood tests, including PDW, were obtained at hospital admission. The primary endpoint was in-hospital death of all causes. The secondary endpoint was all-cause death at follow-up. A receiver operating characteristics (ROC) curve was used to test PDW as a predictor of the primary endpoint and to obtain the best cut-off point. Then we transformed PDW into a categorical variable with 2 groups and conducted a univariate regression analysis to test the strength of prediction. We then performed analysis for the secondary endpoint, testing the cutoff in a Cox regression model. Results: Between January and December 2010, 218 patients were diagnosed APE by MSCT (age 73±16 years, 102 males). For the outcome in-hospital mortality, area under the curve (AUC) was 0,741 (p≤ 0,001). We considered the best cut off point to be 17,55 (sensitivity 68%, specificity 78%). In the univariate regression analysis, a PDW higher than 17,55 was found to be strongly associated to worse outcome [odds ratio (OR) 7,212; 95% confidence interval (CI) 2,852–18,233; p≤0,001)]. For the outcome all cause mortality at follow up after discharge, AUC was 0,623 (p=0,01). A 17,45 cut off point was found to predict the secondary endpoint with a sensitivity of 48% and a specificity of 73%. In a Cox regression analysis, a value higher than the cut-off was associated with lower event-free survival (hazard ratio (HR) 2,52; 95% CI 1,46-4,35; p≤0,001). Conclusion: PDW is a predictor of both in-hospital mortality and all cause mortality at follow-up after APE.

Platelet volume indices have low diagnostic efficiency for predicting bone marrow failure in thrombocytopenic patients

The aim of the present study was to evaluate the predictive efficiency of mean platelet volume (MPV) and platelet size deviation width (PDW) for bone marrow failure (BMF) in thrombocytopenic patients. Platelet count, MPV and PDW data were retrieved from the records of 574 unselected thrombocytopenic patients from between March 2010 and March 2011, of which 182 patients with a platelet count <20×109/l were excluded from further study. A total of 392 valid thrombocytopenic patients were included in the present study and divided into two groups: 124 patients with idiopathic thrombocytopenia purpura (ITP) and 268 with BMF. The predictive efficiency of MPV and PDW were tested for the diagnosis of BMF. Significant differences were observed in the age distribution, platelet count, MPV and PDW between the ITP and BMF groups. The platelet count was positively correlated with MPV and PDW in the patients with ITP but not BMF. The negative-predictive values of MPV and PDW for BMF were 59.3 and 58.9%, respectively, with an MPV threshold of ≥11.0 fl and a PDW threshold of <16.0%. The positive-predictive values of MPV and PDW for BMF were 88.4 and 83.9%, respectively, with an MPV threshold <8.0 fl and a PDW threshold ≥17.5%. The areas under the curves (AUCs) of MPV and PDW were 0.281 and 0.700, respectively, for the diagnosis of BMF. The negative and positive-predictive values of MPV for BMF at different thresholds were not as conclusive as described in previous studies. MPV and PDW do not have sufficient specificity and sensitivity for the diagnosis of BMF in thrombocytopenic patients.

Platelet associated IgG may be related with thrombocytopenia in patients with myelodysplastic syndromes

Thrombocytopenia is common in patients with myelodysplastic syndromes (MDS) and immune destruction of platelets could be an important factor for its occurrence. We prospectively analyzed platelet-associated IgG (PAIgG) through platelet immunofluorescence test (PIFT), mean platelet volume (MPV), platelet size deviation width (PDW) and glycocalicin index (GCI) of 54 patients with MDS, classified according to the International Prognostic Scoring System (IPSS). Thrombocytopenia (platelet count<100×109/L) was correlated with a higher amount of PAIgG, significantly higher MPV and increased GCI. In addition, worse prognosis IPSS groups were associated with a higher positivity of PIFT, which could be indicative of advanced disease.

Platelet-Associated IgG May Be Associated with Thrombocytopenia In Patients with Myelodysplastic Syndromes

AbstractAbstract 2943 Background.Myelodysplastic Syndromes (MDS) are a heterogeneous group of bone marrow disorders characterized by ineffective and dysplastic hematopoiesis, progressive bone marrow failure, cytopenias and a high risk of transformation into acute leukemia. Thrombocytopenia is detected in up to two thirds of patients with MDS and severe thrombocytopenia is present in approximately 10%. Besides ineffective thrombopoiesis, immune destruction of platelets could be an additional factor in the genesis of thrombocytopenia, since immunological abnormalities are also frequent in patients with MDS. The detection of platelet associated IgG (PAIgG) by immunofluorescence (platelet immunofluorescence test or PIFT) is a highly sensitive assay. In addition, some morphological platelet indices (PDW and MPV) are correlated with the occurrence of immune thrombocytopenia. We prospectively analysed platelet-bound IgG and platelet indices (PDW and MPV) in 35 patients with MDS. Methods:Thirty-five patients with MDS (mean age ± SD: 63 ± 19 yo; range 21–89 yo; 15female/20male) were evaluated. According to FAB, 27 patients were classified as RA, 5 as RARS and 3 as RAEB. Clinical manifestations of immunological disorder were not present in this population. Blood samples were analyzed by PIFT, in order to detect platelet associated IgG and results were expressed as a ratio of patient fluorescence/negative control fluorescence (R). Cell-dyn Sapphire blood cell analyzer (Abbott, Illinois, USA) was used to measure platelet count, mean platelet volume (MPV) and platelet size deviation width (PDW). Thrombocytopenia was defined as a platelet count <100 × 109/L. All samples were analyzed on the day of collection. Results.Platelet counts of the entire population ranged from 6.7 to 708 ×109/L, with median of 95.4 × 109/L. Eighteen patients (51.43%) had platelet count <100 × 109/L. A strong association between thrombocytopenia and PAIgG measured by PIFT (R) was demonstrated taking into account three analysis: an inverse correlation between the number of platelets and the fluorescence ratio (p=0.01, r=-0.39, Spearman test), the higher positivity of PIFT in patients with platelet count <100 × 109/L (p=0.007, Wilcoxon rank sum test) and a lower platelet count in patients with positive PIFT (p=0.059, Wilcoxon rank sum test). MPV was significantly higher in patients with platelet count <100 × 109/L (median, min-max: 9.38, 6.9–23.1 vs 8.46, 4.88–12.83; p<0.001, Wilcoxon rank sum test). PDW showed no statistical difference between these groups. Discussion: Immune thrombocytopenia is a relatively frequent hematological disorder of unknown origin and until today depends mainly upon clinical diagnosis. Assays for the detection of glycoprotein-specific antibodies such as MAIPA (monoclonal antibody-specific immobilization of platelet antigens) are highly specific but less sensitive than PIFT. MAIPA is laborious and require a certain amount of platelets, which is not always available in thrombocytopenia Thus, PIFT could be recommended as a screening test to discriminate patients with MDS in whom the hyperdestructive component of thrombocytopenia is important. Our results also showed a higher MPV in patients with platelet count <100 × 109/L, suggesting that this index may be of interest for detection of immune-mediated hyperdestructive thrombocytopenia in MDS. Conclusion:Thus, we propose that a combination of a simple index as MPV and a highly sensitive and easy to perform screening test for PAIgG as PIFT could be applied to select a subset of MDS patients in which we would be able to prevent the overuse of unnecessary platelet transfusions and who could be candidates for an immunosuppressive therapeutic approach. Supported by INCTS, FAPESP, CNPq. Disclosures:No relevant conflicts of interest to declare.

Use of the Platelet Indices for Differential Diagnosis of Pediatric Immune Thrombocytopenic Purpura (ITP)

Introduction: The prognosis of pediatric immune thrombocytopenic purpura ( ITP ) has a favorable prognosis, about 80 % of ITP children will be cured in 6 months with or without therapy, the rest of patients develop to chronic ITP. However, it is difficult to predict the course of this disease at the time of diagnosis. Recent advances of automated blood cell analyzer enable to measure various blood cell parameters. Among these parameters, platelet indices such as mean platelet volume (MPV), platelet size deviation width (PDW) and platelet-large cell ratio (P-LCR) has brought about some information for thrombocytopenia. We studied the significance of such platelet indices in the differential diagnosis of immune thrombocytopenic purpura ( ITP ) and their ability to discriminate the clinical courses of ITP.Methods: Ninety-three patients were enrolled this study at our institution from 2004 to 2006. Their ages ranged from 1 to 17 years ( media 4.3 years ). Of 93, patients were divided into two goups for analysis, according to the diagnosis of ITP. 34 were diagnosed as ITP and 59 were diagnosed various blood diseases other than ITP. In these 59 non-ITP patients, five were with thrombocytopenia ( platelet count < 100.0 × 109/L ), the other without thrombocytopenia. Of 34 ITP patients, 29 were acute subtype and 5 were chronic. The Sysmex-XE2100 automated blood cell analyzer (Sysmex, Kobe, Japan) was used to measure the blood parameters, including the platelet indices.Results: According to MPV, PDW and P-LCR, there were no significant differences between ITP patients and non-ITP. In children with ITP, there were significant inverse correlations between the platelet count and evaluated parameters, MPV (R2=0.376), PDW (R2=0.26) and P-LCR(R2=0.338). But no significant correlations were found between the platelet count and these evaluated platelet indices in non-ITP. Also, we have found all platelet indices were significantly higher in chronic ITP than in acute ITP. In particular, PDW (9.910 vs 13.080) and P-LCR (21.071 vs 33.220) showed marked differences between the two groups.Conclusions: ITP is considered as a result of hyper-destruction of platelets. Increase of platelet count is regarded as decrease of destruction of platelets. Our data suggested that platelet indices, MPV, PDW and P-LCR showed the useful information for the degree of platelet destruction and the ability to predict the clinical courses of ITP.

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

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.

Diagnostic value of platelet size indices in thrombocytopenia

Objective To investigate the role of platelet indices in the differentiation of thrombocytopenia caused by bone marrow diseases and thrombocytopenia caused by non-marrow diseases.Methods Mean platelet volume(MPV),platelet crit(PCT)and platelet size deviation width(PDW)of 76 othromboeytopenia(TP)patients,66 immune thrombocytopenia purpura(ITP)patients,8 secondary thrombocytocritpenia purpura(STP)patients,8 acquired pure megakaryocytic thrombocytopenia purpura(AATP)patients,140 malignant hematological diseases(MHD)(including acute leukemia,aplastic anemia and myelodysplastic syndromes)patients and 100 healthy people were respectively determined by blood cell analyzer Cell-Dyn 3700.Result Compared with control group,the MPV of the patients with MHD significantly decreased,and then the PDW of them increased.For patients with STP,the MVP and PDW markedly increased.The MVP of patients with AATP was normal,and PDW significantly increased.The MPV,PCT and PDW of ITP and TP showed marked difference(P＜0.01).In contrast with the control group,the MPV,PCT and the PDW of patients with hemopathy and patients with ITP were remarkably different(P＜0.01).Compared with the marrow TP and the non-marrow TP or control group,MPV and PDW showed significant difference(P＜0.01).During the effective treatment of patients with ITP,PLT increased and then MPV and PDW decreased.Conclusion The level changes of MPV and PDW,in particular MPV can primarily judge the cause of thrombocytopenia (MPV＜reference value as caused by bone marrow diseases but MPV＞reference value as caused by bone marrow diseases).In addition,during the effective treatment of patients with ITP,with changes of MPV and PDW present 5 days earlier than that of PLT,may used to observe the therapeutic effect.Myelodysplastic syndromedynamic observation of the platelet parameter helps for the differential diagnosis,judgment of the states of the diseases and observation of the effectiveness of therapy of ITP. Key words: Thrombocytopenia; Platelet size indices; Mean platelet volume; Platelet distribution width

Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia

We investigated the significance of the platelet indices, mean platelet volume (MPV), platelet size deviation width (PDW), and platelet-large cell ratio (P-LCR), in the diagnosis of thrombocytopenia by comparing these levels in 40 patients with hypo-productive thrombocytopenia (aplastic anaemia; AA) and 39 patients with hyper-destructive thrombocytopenia (immune thrombo-cytopenia; ITP). The sensitivity and specificity of platelet indices to make a diagnosis of ITP were also compared. All platelet indices were significantly higher in ITP than in AA, and platelet indices showed sufficient sensitivity and specificity. The area under the curve (AUC) of the receiver operating characteristics curve of platelet indices was large enough to enable the diagnosis of ITP. P-LCR and PDW had the largest AUCs, which indicated that these values were very reliable for immune thrombocytopenia. Our results suggest that these indices provide clinical information about the underlying conditions of thrombocytopenia. More attention should be paid to these indices in the diagnosis of thrombocytopenia.