Platelet Count Values Research Articles

Influence of Anticoagulants on Platelet Counts: A Study and Recommendations From the French Speaking Cellular Hematology Group (GFHC).

For complete blood count, ethylenediaminetetraacetic acid (EDTA) is universally used and has been recognized as the most robust anticoagulant. However, it may lead to pseudothrombocytopenia (PTCT), due to the formation of platelet clumps, which is currently followed by resampling on sodium citrate. Other possible anticoagulants are citrate theophylline adenosine dipyridamole (CTAD) and MgSO4. These anticoagulants were compared here for resolution of PTCT and platelet count values and stability. Paired blood samples were used to compare the four anticoagulants. First, samples containing clumps on EDTA were compared to samples collected on sodium citrate (335), CTAD (31), or MgSO4 (160). For platelet counts, compared series were of respectively, 168, 191, and 87, paired to PTCT-free EDTA samples. Finally, platelet count stability was evaluated over 2-24 h. MgSO4, followed by CTAD, was the most efficient to avoid platelet clump formation, while sodium citrate performed poorly. Regarding platelet count, significantly lower values were obtained with sodium citrate (p < 0.0001), with more samples (35% vs. 6.5%) below the 150 × 109/L threshold. Conversely, CTAD yielded similar values as EDTA, while higher counts were observed with MgSO4 (p = 0.008). Finally, platelet count stability began to decrease at 4 h for sodium citrate, while the other anticoagulants were stable for at least 8 h, up to 12 h for MgSO4 and 24 h for EDTA. This real-life study confirms that sodium citrate should no longer be used to improve platelet counts in patients with platelet clumps, CTAD, if available, and MgSO4 being much better alternatives.

The associations among platelet count, mean platelet volume, and erectile dysfunction: an observational and Mendelian randomization study.

While previous studies have explored the associations and causalities among platelet count (PC), mean platelet volume (MPV), and erectile dysfunction (ED), further investigations are needed to clarify these relationships using advanced methodologies and analyzing specific populations. To investigate the associations and causalities among PC, MPV, and ED using observational study and Mendelian randomization (MR) analysis. A total of 114 patients with ED and 158 healthy control participants underwent a fasting blood draw to test for PC and MPV along with a comprehensive laboratory examination. The International Erectile Function Index was used to diagnose ED. Genetic variants of ED were obtained from individuals of European ancestry including 6175 ED cases and 217 630 controls. PC and MPV values were obtained from the UK Biobank and Investigating the effect of varying the whole blood inter-donation interval (INTERVAL) studies, encompassing a cohort of 173 480 individuals of European descent. Inverse-variant weighted (IVW), weighted median (WM), and MR-Egger methods were employed in MR analysis to explore the causal effects between variables to assess the impact of PC and MPV on ED. Various sensitivity analyses were employed to ensure the reliability of the results. Both observational study results and MR results revealed that elevated PC levels were associated with a heightened risk of ED, whereas reductions in MPV were linked to a decreased risk. Logistic regression analysis indicated that an increased PC was associated with a greater risk of ED, with an odds ratio (OR) of 1.14 (95% CI: 1.08, 1.22; P = .005), whereas decreased MPV was linked to an increased risk for ED, with an OR of 0.65 (95% CI: 0.48, 0.88; P = .003). Our MR analysis also revealed that genetically predicted PC was associated with a 1.09-fold increased risk of ED (95% CI: 1.01, 1.18; P = .016). Conversely, genetically predicted MPV was linked to a 0.93-fold increased risk of ED (95% CI: 0.88, 0.99; P = .014). The absence of heterogeneity (P > .05) and pleiotropy (P > .05) was confirmed through Cochran's Q tests and MR-Egger regression. Exclusion of individual single-nucleotide polymorphisms (SNPs) did not alter the robustness of the results. In clinical work, it is an important guide for the prevention, diagnosis, and treatment of ED. Our study employed a combination of observational studies and MR studies to strengthen our evidence. The observational study's sample size was relatively small, and MR was limited to individuals of European ancestry. A high PC and a low MPV are associated with an increased risk of ED, highlighting the importance of addressing platelet parameters in ED management.

Correlation between Haematological Features and Severity of RT-PCR Positive COVID-19 Patients

Background: Haematological tests have an important role in early diagnosis of the COVID-19 patient’s disease condition, considering the information they provide to physicians regarding the inflammatory process. This information includes leukocyte count and characteristics such as neutrophil or lymphocyte-dominance, inflammation (CRP) Serum ferritin and coagulation profile (D-dimer). Aim of this study was to investigate the association of hematological parameters with severity of the disease and identify the association of magnitude of any cytopenia and pancytopenia with the severity of COVID-19 patients. Materials and methods: This prospective observational study was conducted at dedicated COVID unit of Chattogram Maa O Shishu General Hospital from March 2021 to August 2021. A total of 100 RT-PCR(+ve) COVID cases were included in this study. Automated hematology analyzer was used to determine complete blood count (Total WBC count, absolute and relative count of each WBC type, RBC, and platelet count). Results: Majority patient were female (61%). Among all patient 87% patients were above 35 years of age. Patient with mild disease were comparatively younger than patient with severe disease. Major presenting complaints were cough (88%) shortness of breath (60%) fever (59%) sore throat (30%) and fatigue (26%). Raised pulse and respiratory rate were seen according to disease severity. Total WBC (p=0.0038) Neutrophil (p=0.0001) serum ferritin (p=0.0205) CRP (p=0.0004) and Ddimer (p=0.0004) were significantly increased in severe group and the patient with critical condition. No statistically significant difference was seen in the median value of platelet count (p=0.4364). Conclusion: Leukocytosis, Neutrophilia, elevated serum ferritin, CRP and D-dimer are significantly increased in patients with severe and critical disease condition of COVID-19 patient. Lymphopenia also featured in these patients, which is associated with the severity of disease. Chatt Maa Shi Hosp Med Coll J; Vol.22 (2); July 2023; Page 8-13

Prognostic value of neutrophil to lymphocyte ratio and platelet indices in cats with feline panleukopenia

The aim of this study was to ascertain the prognostic significance of the neutrophil to lymphocyte ratio (NLR) and platelet indices during hospital admission in cats with feline panleukopenia (FPV). A prospective observational study was conducted on 24 cats diagnosed with FPV. The results of the study demonstrated a significant decrease in NLR, platelet count (PLT), and platelet concentration (PCT) in the FPV survivor group compared to the control group. Furthermore, these parameters exhibited a notable decline in the FPV non-survivor group when compared to both the control group and the FPV survivor group. In contrast, mean platelet volume (MPV) and platelet distribution width (PDW) were significantly elevated in the FPV non-surviving cats compared to the control group. Moreover, receiver operating characteristic (ROC) curve analysis was employed to identify a prognostic cut-off value for predicting the prognosis of cats with FPV. The positive predictive values (PPVs) for survival were determined to be 90 %, 95 %, 85 %, 85 %, 85 %, and 75 %, respectively, using cut-off values of NLR (≤ 0.29), PLT (≤ 202.5 ×10³/µL), PCT (≤ 0.19 %), MPV (≥ 10.3 fL), and PDW (≥ 34.9 %). Based on the sensitivity, specificity and positive predictive values obtained from the ROC analysis, it was concluded that the NLR, MPV, and PLT are excellent biomarkers for determining prognosis in cats with FPV. Nevertheless, the PLT level is of greater significance, exhibiting a higher AUC.

The Role of Aspartate Aminotransferase / Platelet Ratio Index Score in Predicting Intrahepatic Cholestasis of Pregnancy and its Relationship with Total Bile Acid Level: A Case-Control Study from a Tertiary Center

OBJECTIVES: The aim of this study is to examine the value of the first-trimester aspartate aminotransferase to platelet ratio index (APRI) score in predicting intrahepatic cholestasis of pregnancy (ICP) occurring later in pregnancy. Another aim of the study is to determine the relationship between APRI scores and total bile acid (TBA) levels in pregnant women with ICP. STUDY DESIGN: This retrospective case-control study was conducted by examining the hospital records of women diagnosed with ICP (n=66) and healthy controls (n=70) among women followed during pregnancy. Hemoglobin (Hb), platelet count (PLT), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) values of all patients were obtained from routine blood test data taken in the first and third trimesters. The first and third-trimester APRI scores of the patients were calculated. Demographic data, laboratory findings, and APRI scores of women with and without ICP during pregnancy were compared. Using Roc analysis, the values of AST, ALT, PLT values, and APRI scores were examined in predicting ICP among the first trimester findings of the patients. In addition, TBA levels of patients with ICP at the time of diagnosis were obtained from hospital records. The relationship between the first and third-trimester APRI scores and TBA levels in patients with ICP was evaluated using correlation analysis. RESULTS: In the first and third-trimester laboratory values, AST and ALT levels and APRI scores were found to be higher and PLT values were lower in patients with ICP compared to healthy controls. Among the first trimester measurements of these data, the APRI score had the highest predictive value in predicting ICP (AUC values are 0.648 for AST, 0.655 for ALT, 0.633 for PLT, and 0.705 for APRI). In an examination of patients with ICP, the APRI score calculated in the first and third trimesters showed a positive correlation with the TBA level at diagnosis (r=0.435 p&lt;0.001 for the first trimester and r=0.433 p&lt;0.001 for the third trimester in the Spearman analysis). CONCLUSIONS: In the future, the APRI score calculated in the first trimester of pregnancy may be used as a tool to predict ICP that may occur in the following weeks. There may be a positive correlation between APRI score and serum TBA level in patients with ICP.

Correlation Between Transient Elastography and Non-invasive Biomarker Scores for the Detection of Liver Fibrosis.

Background and aim The study aimed to address the need for reliable and non-invasive biomarkers (NIBM) for detecting fibrosis among patients with chronic liver disease (CLD). Material and methods This was a diagnostic validation study executed at the Department of Gastroenterology, Jinnah Hospital,Lahore. The study was carried out from July 2023 to June 2024, enrolling a total of 88 patients using non-probability consecutive sampling. Patients with chronic liver disease (CLD) due to chronic viral hepatitis B (HBV), hepatitis C (HCV), and non-alcoholic fatty liver disease (NAFLD) were included in the study. A cut-off value of 12.5 kPa was used to label fibrosis using transient elastography. Blood samples were collected forrecording values of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and platelet count, and the appropriate formulas were applied to calculate the aspartate aminotransferase to platelet ratio index (APRI), Fibrosis-4 (FIB-4), AST/ALT-to-platelet ratio index (AARPRI), and BARD scores (a scoring system for NAFLD fibrosis that predicts the risk of advanced fibrosis in NAFLD patients; the components include body mass index (BMI), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, and diabetes status). Spearman's rank correlation coefficient was used to assess the strength and direction of the association between these variables. Results Among the 88 patients, 61.4% were male and HCV was the most common cause of CLD (63.6%).Statistically significant correlations were found between transient elastography and NIBM: FIB-4 (p < 0.001, area under receiver operating characteristic curves (AUROC), 0.835; sensitivity, 47.7%; specificity, 90.9%), APRI (p = 0.020; AUROC, 0.769; sensitivity, 25.0%; specificity, 93.2%), AARPRI (p = 0.011, AUROC, 0.782), and BARD (p = 0.033; AUROC, 0.648). FIB-4 demonstrated the strongest correlation withliver stiffness measurements (LSM) (r = 0.617), indicating its reliability in detecting liver fibrosis, whereas the aspartate aminotransferase to alanine aminotransferase ratio (AAR) showed the weakest correlation (r = 0.163). Conclusion This study reported that FIB-4 displayed the highest correlation with liver stiffness measurements obtained through transient elastography in detecting liver fibrosis. APRI and AARPRI reported a moderate correlation, while AAR and BARD were less consistent in their performance. These findings suggest that FIB-4, APRI, and AARPRI are effective non-invasive tools for assessing liver fibrosisin a limited resource setting where transient elastography is not available.

The Role of Neutrophil-to-Lymphocyte Ratio and Mean Platelet Volume in Diagnosing Odontogenic and Non-odontogenic Head and Neck Abscesses.

Introduction Head and neck abscesses are categorized as either odontogenic, originating from dental infections, or non-odontogenic, arising from soft tissue inflammation. This article aimed to investigate inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV), and compare them against established diagnostic parameters such as white blood cell (WBC) count, neutrophil count (Neu), lymphocyte count (Ly), platelet count (PLT), C-reactive protein (CRP), and procalcitonin (PCT). Material and methods Our retrospective analysis of a prospective study involved 80 patients, including 50 individuals (56% men) with an average age of 41.6±18.18 years diagnosed with odontogenic abscesses and 30 patients (66.7% men) with an average age of 44.53±15.49 years diagnosed with non-odontogenic head and neck abscesses, during the period from July 2021 to June 2022. The complete blood count provided data on WBC, Neu, Ly counts, MPV, and PLT using a 5-diff hematological analyzer. The MPV to PLT index (MPI) was calculated by dividing MPV by PLT, neutrophil-to-lymphocyte ratio (NLR) by dividing Neu by Ly, and platelet-to-white blood cell ratio (PWR) by dividing PLT to WBC. A latex-enhanced immunoturbidimetric assay was used to determine CRP (mg/L) on Cobas 6000 and PCT (ng/mL) on Advia 1800. Results PLT, PCT, and Ly were lower in patients with odontogenic abscesses compared to those with non-odontogenic abscesses (p<0.05), while CRP and Neu were significantly elevated in the odontogenic abscess group (p<0.05). In the non-odontogenic abscess group, men presented higher CRPlevels (50.39±64.99 ng/mL versus 9.77±8.36 mg/L), MPI (0.036±0.017 ng/mL versus 0.029±0.01 ng/mL), and NLR (5.6±5.66 versus 3.09±2.2) compared to women (p<0.05). In contrast, women exhibited higher PLT values (390.78±197.129x109/L versus 220.33±55.153x109/L) and PWR (43.88±32.72 versus 23.86±9.34) compared to men (p<0.05). A significant combination of Ly% and Neu% was identified for predicting the MPVvalue in the non-odontogenic abscess group (R²=0.126, p=0.042), NLR and PWR as a predictor of CRP in both study groups (p<0.05) (R²=0.3for the non-odontogenic abscess group, R²=0.448 for the odontogenic abscess group), and NLR and PWR as predictors for PCT values in those with non-odontogenic abscesses (R²=0.239, p=0.025). Discussion Despite the expected association between elevated MPV and heightened inflammatory responses, our findings revealed an inverse correlation between MPV and Neu and Ly in patients with non-odontogenic abscesses. This indicates complex interactions in immune responses during inflammation and underscores the need for further investigation to clarify MPV's role across different abscess types. Integrating traditional inflammatory markers such as CRP and PCT with indices such as NLR and MPV can enhance our understanding of inflammatory responses and improve predictions regarding patient outcomes in head and neck abscesses. Conclusion Our study confirms the value of combining traditional inflammatory markers such as CRP and PCT with indices such as NLR and MPV to assess the severity of infections in head and neck abscesses. These biomarkers provide significant insights into inflammatory responses and may improve patient outcome predictions. However, further research with larger, diverse populations is needed to fully integrate these markers into routine clinical practice for better management of such infections.

Effectiveness of partial splenic embolization in colorectal cancer patients with chemotherapy-induced thrombocytopenia: results of a single institution retrospective study.

To evaluate the safety and efficacy of partial splenic embolization (PSE) in treating chemotherapy-induced thrombocytopenia (CIT) in patients with colorectal cancer who failed to respond to platelet growth factor therapy. 56 patients who underwent PSE were retrospectively analyzed. Based on the inclusion and the exclusion criteria, 29 patients were eligible for the study, of whom one underwent twice PSE procedures due to recurrent thrombocytopenia. The clinical characteristics were retrospectively analyzed with respect to efficacy, safety and outcome. 60.0% of patients restarted antineoplastic therapy after PSE. There was a positive correlation between difference value of platelet count and embolization material size (Eta Squared = 0.252, p < 0.05). The correlation between the absolute volume of spleen embolized and postoperative complications was analyzed, with a statistically significant result (p < 0.001). The mean preoperative spleen volume, the preoperative platelet count, postoperative platelet count and difference value of platelet count in the non-cirrhotic group were larger than those in the cirrhotic group (p < 0.001). The mean overall survival was 47.7 ± 7.7 months. PSE is safe and effective in the treatment of CIT patients with colorectal cancer. The larger the embolized particle, the more platelets grew. The severity of complication was also positively correlated with the absolute volume of spleen embolized. Therefore, large particle embolization materials can be used to improve the efficacy of PSE and reduce complications. For CIT patients with cirrhosis, PSE was less effective in improving platelet count than those without cirrhosis.

Platelet Indices in Patients With Gram-Negative and Gram-Positive Sepsis: A Retrospective Cross-Sectional Study.

Different inflammatory processes and sepsis can significantly affect the number of platelets and platelet indices. Therefore, in this study, total platelet count (PLT), thrombocrit (Pct), platelet distribution width (PDW), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were analyzed in patients with Gram-negative and Gram-positive bacterial sepsis and in sterile blood cultures. Inclusion criteria were an increased number of inflammatory parameters (elevated values ​​of leukocytes,C-reactive protein (CRP), procalcitonin (PCT), andpositive blood culture. Exclusion criteria were patients who did not have elevated values ​​of inflammatory parameters and did not have a positive blood culture.Samples were collected from patients who had sepsis confirmed by blood cultures at the Department of Microbiology and Molecular Diagnostics at University Clinical Hospital Mostar in the period from 2019 to 2022. Three groups were analyzed, patients who had sterile blood cultures, patients with blood cultures with isolated Gram-positive bacteria, and patients with blood cultures with isolated Gram-negative bacteria. Specific infectious agents were identified for each group of patients. In addition to the above, PLT, Pct, MPV, PDW, P-LCR, PCT, CRP, the total number of leukocytes, and the number of neutrophil leukocytes were analyzed in each group. The values of PCT, CRP, and the number of neutrophile leukocytes were significantly higher in patients with Gram-negative sepsis as compared to Gram-positive sepsis and to control group. Patients with sepsis have decreased PLT and Ptc and increased values of MPV, PDW, and P-LCR. In sepsis caused by the Gram-negative bacteria, i.e., Escherichia coli, Klebsiella pneumoniae, and Acinetobacter baumannii, the values of the same parameters were more changed compared to sepsis caused by Gram-positive bacteria, i.e., Streptococcus pneumoniae, Enterococcus spp., and methicillin-resistant Staphylococcus aureus (MRSA). When comparing Gram-negative negative bacteria, PLT was lowest in sepsis caused by Escherichia coli, the PDW value was highest in sepsis caused by Acinetobacter baumannii, and MPV and P-LCR were the highest in sepsis caused by Klebsiella pneumoniae. Our study showed that platelet indices are significantly changed in patients with sepsis. Patients with sepsis have decreased values of PLT and Pct and increased values of MPV, PDW, and P-LCR, indicating an increase in thrombocyte production. Moreover, the results were more prominent in sepsis caused by Gram-negative bacteria compared to sepsis caused by Gram-positive bacteria.

Platelet Indices – Are They Really Biomarkers in Psoriasis? A Cross-sectional Study

Background: Psoriasis is a chronic inflammatory disorder with multiple systemic manifestations in common with other inflammatory disorders. Platelet activation has recently been proposed a major pathogenic factor in psoriasis. Mean platelet volume (MPV) and platelet distribution width (PDW) are considered platelet activation markers. Although there are various inflammatory markers reported to be abnormal in psoriasis, a simple cost-effective and clinically useful marker that could predict the severity of the disease and be used to know about its association with systemic abnormalities and response to treatment is still under study. Aim: The aim of our study was to look at the association of platelet indices with psoriasis and its severity. Methods: This was a single-center cross-sectional study in which 50 patients with psoriasis and 50 apparently healthy age and sex-matched controls who fulfilled the inclusion and exclusion criteria were enrolled after obtaining informed consent. A detailed history was elicited, and a clinical examination was done including anthropometric measurements and calculation of psoriasis area and severity index (PASI). Investigations including hemoglobin, red blood cell (RBC) count, packed cell volume (PCV), mean corpuscular volume, mean corpuscular hemoglobin (MCH), MCH concentration, white blood cell (WBC) and platelet count, plateletcrit, MPV, PDW, and red cell distribution width (RDW) were done. Results: Out of 50 psoriasis patients recruited, 40 (80%) had moderate-to-severe psoriasis, whereas 10 had mild psoriasis (10%) based on PASI scores. In majority of cases, the hemoglobin, PCV, RBC, and WBC counts were within the normal range and were comparable with that of controls. There was no statistically significant difference in the mean values of platelet count, MPV, PDW, plateletcrit, and RDW between cases and controls. There was no significant association between platelet indices and severity of psoriasis. Conclusion: There was no significant association between platelet indices including RDW and the presence or absence of psoriasis in our study. Furthermore, among patients with psoriasis, there was no significant association between platelet indices and severity of the disease.

Antiphospholipid Antibodies Modify the Prognostic Value of Baseline Platelet Count for Clinical Outcomes After Ischemic Stroke.

Antiphospholipid antibodies (aPLs) have been reported to be involved in platelet-mediated thrombosis and inflammation, but the impact on the prognosis of ischemic stroke remains unclear. We aimed to examine whether the association between baseline platelet count (PLT) and long-term clinical outcomes within 2 years after ischemic stroke onset is modulated by aPLs. A total of 2938 patients with ischemic stroke were included in this prospective cohort study. Cox proportional hazards regression models were used to assess the association between the baseline PLT stratified by aPLs status and 2-year clinical outcomes after stroke onset, and an interaction effect between PLT and aPLs on clinical outcomes was tested by likelihood ratio test. There was a significant interaction effect of aPLs and PLT on recurrent stroke (Pinteraction=0.002) and cardiovascular events (Pinteraction=0.001) within 2 years after stroke onset. After multivariate adjustment, high PLT was associated with increased risks of recurrent stroke (hazard ratio [HR], 2.78 [95% CI, 1.03-7.45]; Ptrend=0.039) and cardiovascular events (HR, 2.58 [95% CI, 1.12-5.90]; Ptrend=0.024) when 2 extreme tertiles were compared among patients with aPL positive, but not among those with aPL negative. The aPLs had a modifying effect on the association between PLT and clinical outcomes within 2 years after ischemic stroke onset. Increased PLT was associated with recurrent stroke and cardiovascular events after ischemic stroke onset among patients with aPL positive, but not in those with aPL negative.

Quantitative and functional changes in platelets and fibrinogen following cardiopulmonary by-pass in children

IntroductionCardiopulmonary bypass (CPB) causes coagulopathy, increasing the risk of postoperative bleeding and mortality. The underlying causes of post-CPB coagulopathy and the factors associated with its occurrence are not yet fully understood. This study assesses platelet and fibrinogen concentration and function following CPB in children with congenital heart diseases (CHD).MethodsWe analyzed prospective data from 104 patients aged 0–16 years who underwent CPB surgery for CHD. Blood samples were collected before surgery and within 30 min of CPB completion. In addition to usual coagulation tests, functional analyses were performed using point of care systems with thromboelastometry and impedance aggregometry.ResultsPlatelet count, fibrinogen concentration, and platelet and fibrinogen activities significantly decreased after CPB. The duration of CPB was directly associated with a reduction in platelet count and fibrinogen level (r = −0.38, p &amp;lt; 0.001; r = −0.21, p = 0.03, respectively), but not with their measured activity. Postoperative percentages of baseline values for platelet count (58.36% [43.34–74.44] vs. 37.44% [29.81–54.17], p &amp;lt; 0.001) and fibrinogen concentration (73.68% [66.67–82.35] vs. 65.22% [57.89–70.83], p &amp;lt; 0.001) were significantly higher in patients who did not experience hypothermia during surgery. Age was inversely associated with the decrease in platelet count (r = 0.63, p &amp;lt; 0.001), TRAPTEM AUC (r = 0.43, p &amp;lt; 0.001), fibrinogen concentration (r = 0.44, p &amp;lt; 0.001) and FIBTEM MCF (r = 0.57, p &amp;lt; 0.001).ConclusionPost-CPB coagulopathy is multifactorial and not solely attributed to hemodilution. It also involves functional changes in coagulation cascade components, which can be demonstrated by thromboelastometry and impedance aggregometry. Young children, patients requiring prolonged CPB surgery, or those experiencing hypothermia are particularly affected.

O21 PLATELET COUNT-TO-PLATELET DISTRIBUTION WIDTH RATIO AND OTHER PLATELET INDICES AS COST-EFFECTIVE MARKERS OF PREECLAMPSIA: A CASE CONTROL STUDY

Background and objective: Platelet indices, like platelet count (PC), plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW), and their ratios have shown to be cost-effective and better predictors of preeclampsia (PE). However, PC/PDW ratio was not studied. Thus, this study aimed to compare platelet indices and their ratios between pregnant women with and without PE. Methods: An analytical, comparative, case-control study. Two groups were compared; pregnant women with PE (case, n=24) and without PE (control, n=72). The differences between cases and controls were compared using Student's t-test and Mann–Whitney U-test for continuous variables and chi-square tests and Fisher's exact test for categorical. Multivariable linear regression analysis for hematological parameters was performed to assess the effect of gestational age. Logistic regression was performed to calculate the odds ratio. Receiver operating characteristic curve was used to determine sensitivity, specificity and cutoff values. P &lt; 0.05 was considered significant. Results: There was significant reduction in values of PC (p=0.004), plateletcrit (p=0.012), PC/MPV ratio (p=0.002), and PC/PDW (p= &lt;0.001) among the pregnant women with PE compared to the control study group, while a significant increase was noticed in the values of PDW (p= &lt;0.001) and MPV (p=0.021). PC/PDW had the highest area under the curve (AUC) of 0.767, followed by PDW (AUC=0.752). At the cutoff value of 15.1 (p&lt;0.001) for PC/PDW, sensitivity was 70.8%, and specificity was 81.9%. The odds of diagnosing true positive cases of PE was 11.02 (95% CI =3.79-31.99, p=&lt;0.001) times higher compared to values below it at this cutoff point. Conclusions: Present study suggests that platelet indices are economical tests that can act as indicators of risk of PE. Among all the parameters, PC/PDW has the highest sensitivity and specificity in the detection of PE at the cutoff of 15.1 and has emerged as a better predictor of PE.

Normal Value of Thrombocytes Indices in Indonesian Adults: Focus on Gender and Ages

BACKGROUND: Monitoring platelet count and related indices is crucial for managing hematological disorders. No studies are reporting normal platelet indices in the adult Indonesian population. Therefore, this study was conducted to establish normal reference values for platelet count and indices in a healthy population in Indonesia and investigate their association with platelet count and each parameter.METHODS: This cross-sectional study included healthy adults from both sexes who underwent hematological testing in our laboratory. Two mL of venous blood was drawn and analyzed using an automated machine ADVIA 2120 to identify platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), mean platelet component (MPC), platelet component distribution width (PCDW), mean platelet mass (MPM), platelet mass distribution width (PMDW), and large platelet count.RESULTS: This study included 1037 subjects with median of 27 (18–58) years old. Normal reference range values for platelet indices in adult Indonesians was established, which was significantly different between males and females (p&lt;0.05) in following parameters: platelet count (191.77–400.37 vs. 203.00–433.00 ×109/L), MPV (7.30–9.91 vs. 7.20–10.00 fL), PDW (38.09–59.83 vs. 37.10–58.50%), PCT (0.17–0.33 vs. 0.17–0.35%), PMDW (0.68–1.06 vs. 0.67–1.04 pg) for males vs. females, respectively. However, other parameters such as MPC, PCDW, MPM, and large platelet, did not show any significant differences.CONCLUSION: The reference intervals of platelet indices in the adult Indonesian population were different from previously established reference values, indicating the importance of dedicated reference interval determination with gender consideration.KEYWORDS: thrombocyte indices, platelet count, hematology reference values, blood platelet analysis

A study of non-invasive predictors of esophageal varices in patients with cirrhosis of liver – A cross-sectional study

Background: Current guidelines advise that patients diagnosed with liver cirrhosis undergo screening through upper gastrointestinal endoscopy to detect esophageal varices (EV). Prophylactic measures should be taken for those with large varices on diagnosis and during follow-up. However, this poses a dual challenge, both social and medical, as the number of cirrhotic patients rises while the availability of endoscopy units remains limited. Aims and Objectives: In this study, we aim to evaluate the diagnostic accuracy of the non-invasive predictors such as spleen size, platelet count (PC), and PC/spleen diameter (PC/SD) ratio for the diagnosis of EV. Materials and Methods: This hospital-based prospective observational study was done in the SDM College of Medical Sciences and Hospital, Dharwad, among 50 patients with cirrhosis of liver. Results: Among the 50 patients studied males pre-dominated the study with 80%. Out of the study population, 70% of the patients had varices. For a cutoff point of PC/SD ratio 916, the sensitivity was 71.42% and specificity was 93.3%. For a cutoff value of PC of 1.32 lakhs, the sensitivity was 71.42%, and the specificity was 73.3%. For a cutoff value of the longest SD of 12.40 cm, the sensitivity was 94.30%, and specificity was 33.3%. Conclusion: These non-invasive predictors can be useful screening tools for the diagnosis of EV. These can be effective for the initiation of prophylactic treatment when the endoscopy facility is not available.

Risk of bleeding after abdominal paracentesis in patients with chronic liver disease and coagulopathy: A systematic review and meta-analysis.

Abdominal paracentesis is a common procedure performed for both diagnostic and therapeutic purposes in patients with chronic liver disease and ascites. This review aims to provide an overview of the current evidence on the risk of bleeding associated with abdominal paracentesis. Electronic search was performed using PubMed, MEDLINE, and Ovid EMBASE from inception to 29 October 2023. Studies were included if they examined the risk of bleeding post-abdominal paracentesis or the efficacy of interventions to reduce bleeding in patients with chronic liver disease. Random-effects model was used to calculate the pooled proportions of bleeding events following abdominal paracentesis. Heterogeneity was determined by I 2, τ2 statistics, and P-value. Eight studies were included for review. Six studies reported incident events of post-abdominal paracentesis bleeding. Pooled proportion of bleeding events following abdominal paracentesis was 0.32% (95% CI: 0.15-0.69%). The mean values for pre-procedural INR and platelet count of patients in these studies ranged between 1.4 and 2.0, and 50 and 153 × 109/L, respectively. The highest recorded INR was 8.7, and the lowest platelet count was 19 × 109/L. Major bleeding after abdominal paracentesis occurred in 0-0.97% of the study cohorts. Two studies demonstrated that the use of thromboelastography (TEG) before paracentesis in patients with chronic liver disease identified those at risk of procedure-related bleeding and reduced transfusion requirements. The overall risk of major bleeding after abdominal paracentesis is low in patients with chronic liver disease and coagulopathy. TEG may be used to predict bleeding risk and guide transfusion requirements.

Prognostic role of the neutrophil/lymphocyte ratio in high-risk BCG-naïve non-muscle-invasive bladder cancer treated with intravesical gemcitabine/docetaxel.

To investigate the role of pretreatment neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) in the prediction of response to sequential intravesical therapy, gemcitabine and docetaxel (Gem/Doce), given to patients with bacille Calmette-Guérin (BCG)- naïve high-risk non-muscle-invasive bladder cancer (NMIBC). A retrospective analysis was conducted on 115 patients who received intravesical Gem/Doce for high-risk NMIBC between January 2011 and December 2021. Data were computed as the median (interquartile range [IQR]) or mean (standard deviation [sd]). Cox regression analysis was performed to determine if neutrophilia, NLR, platelet counts, and PLR before instillation therapy were predictive of recurrence-free survival (RFS) and overall survival (OS). Predictive performance was estimated using Uno's C-statistic. The median (IQR) follow-up for the overall cohort was 23 (13-36) months. The mean (sd) values for NLR, PLR and platelet counts were 3.4 (2.3), 142.2 (85.5), and 225.2 (75.1) × 109/L, respectively. NLR was associated with RFS, with a hazard ratio of 1.32 (95% confidence interval CI 1.19-1.46). Concordance analysis showed that NLR had a good ability to predict RFS (C-index: 0.7, P < 0.01). The PLR and platelet count were not associated with RFS and did not predict recurrence. In terms of OS, none of these cellular inflammatory markers showed any prediction value. Pre-treatment NLR provides some predictive accuracy for RFS in high-risk BCG-naïve patients receiving Gem/Doce. Further prospective trials are needed to validate this finding.

The association between heparin sensitivity index and postoperative blood loss in Chinese patients undergoing elective off-pump coronary artery bypass grafting: a single center retrospective study

BackgroundThe heparin sensitivity index (HSI) is closely associated with perioperative ischemic events and increased blood loss in cardiac surgery. Previous studies have produced conflicting results. Therefore, this study aimed to investigate the relationship between HSI and postoperative blood loss specifically in Chinese patients undergoing elective off-pump coronary artery bypass grafting (OPCAB).MethodsPatients underwent OPCAB between March 2021 and July 2022 were retrospectively included. Enrolled patients were classified into Low-HSI (HSILOW; HSI < 1.3) and Normal-HSI (HSINORM; HSI ≥ 1.3) groups. HSI = [(activated clotting time (ACT) after heparin) – (baseline ACT)] / [loading dose of heparin (IU/kg)]. Primary outcome included postoperative blood loss at 24 h. Secondary outcomes were total postoperative blood loss, transfusion requirement of red blood cell (RBC), fresh frozen plasma (FFP), platelet concentrates (PC), and other complications.ResultsWe retrospectively analyzed 303 Chinese OPCAB patients. HSILOW group had higher preoperative platelet (PLT) count (221 × 109/L vs. 202 × 109/L; P = 0.041) and platelet crit (PCT) value (0.23% vs. 0.22%; P = 0.040) compared to HSINORM group. Two groups showed no significant differences in postoperative blood loss at 24 h (460 mL vs. 470 mL; P = 0.252), total blood loss (920 mL vs. 980 mL; P = 0.063), RBC transfusion requirement (3.4% vs. 3.1%; P = 1.000), FFP transfusion requirement (3.4% vs. 6.2%; P = 0.380), and other complications. Preoperative high PLT count was associated with low intraoperative HSI value (odds ratio: 1.006; 95% confidence interval: 1.002, 1.011; P = 0.008).ConclusionsIntraoperative HSI value was not associated with postoperative blood loss in Chinese patients undergoing OPCAB. Preoperative high PLT count was an independent predictor of low intraoperative HSI value.

Liver fibrosis detected by diffusion-weighted magnetic resonance imaging and its functional correlates in Fontan patients.

The evaluation of Fontan-associated liver disease is often challenging. Diffusion-weighted magnetic resonance imaging can detect hepatic fibrosis from capillary perfusion and diffusion abnormalities from extracellular matrix accumulation. This study investigated its role in the evaluation of liver disease in Fontan patients and explored possible diagnostic methods for early detection of advanced liver fibrosis. Stable adult Fontan patients who could safely be examined with magnetic resonance imaging were enrolled, and blood biomarkers, transient elastography were also examined. Forty-six patients received diffusion-weighted imaging; and 58.7% were diagnosed with advanced liver fibrosis (severe liver fibrosis, 37.0%, and cirrhosis 21.7%). Two parameters of hepatic dysfunction, platelet counts (Spearman's ρ: -0.456, P = 0.001) and cholesterol levels (Spearman's ρ: -0.383, P = 0.009), decreased with increasing severity of fibrosis. Using transient elastography, a cut-off value of 14.2 kPa predicted the presence of advanced liver fibrosis, but with a low positive predictive value. When we included platelet count, cholesterol, post-Fontan years and transient elastography values as a composite, the capability of predicting advanced liver fibrosis was the most satisfactory (C statistic 0.817 ± 0.071, P < 0.001). A cut-off value of 5.0 revealed a sensitivity of 78% and a specificity of 82%. In Fontan patients, diffusion-weighted imaging was helpful in detecting liver fibrosis that was correlated with hepatic dysfunction. A simple score was proposed for long-term surveillance and early detection of advanced liver disease in adult Fontan patients. For adult Fontan patients with a calculated score > 5.0, we may consider timely diffusion-weight imaging and early management for liver complications.

Prognostic value of pretreatment platelet count, fibrinogen and d-dimer levels in osteosarcoma patients: A meta-analysis.

Previous studies explored the prognostic value of pretreatment platelet count, fibrinogen, and d-dimer level in patients with several types of cancer, however, a comprehensive conclusion has not been reached in osteosarcoma patients. PubMed, Web of Science, Embase, and CNKI databases were systematically searched for eligible studies up to May 09, 2023, and pooled hazard ratios (HRs) with corresponding 95% confidence intervals (CIs) were calculated to assess the prognostic impact of these indicators in osteosarcoma patients. Twelve studies from China consisting of 1682 patients were finally included. Our findings revealed that an elevated level of pretreatment platelet or d-dimer was associated with a worse outcome of overall survival (platelet: HR = 1.63, 95% CI: 1.18-2.26, P = .003; d-dimer: HR = 2.29, 95% CI: 1.58-3.31, P < .001). Based on current evidence, pretreatment platelet count and d-dimer level could be good prognostic biomarkers for Chinese osteosarcoma patients. However, future validation is also needed.