The use of mean platelet volume for distinguishing the causes of thrombocytopenia in adult patients

Lalita Norrasethada, Wichan Khumpoo, Ekarat Rattarittamrong, Thanawat Rattanathammethee, Chatree Chai-Adisaksopha, Adisak Tantiworawit, Lalita Norrasethada, Wichan Khumpoo, Ekarat Rattarittamrong, Thanawat Rattanathammethee, Chatree Chai-Adisaksopha, Adisak Tantiworawit

Abstract

Establishment and analysis of mean platelet volume (MPV) may be helpful in the discrimination between underproduction or over-destruction of platelets as the causes of thrombocytopenia. The primary objective is to find the cut-off point of MPV for distinguishing causes of thrombocytopenia. The secondary objective is to validate the cut-off value of the MPV by using bone marrow examination. Thrombocytopenic patients were enrolled in a training set and a receiving operating characteristics (ROC) curve was plotted to obtain the cut-off value of MPV. A validation set of patients was recruited to validate the cut-off value. The training set included 240 patients. Half with with underproductive (n=120) and half with over-destructive thrombocytopenia (n=120). The best cut-off value of MPV was 8.8 fL. The validation set included 119 patients in total, again in 2 groups, those with underproductive (n=84) and those with overdestructive thrombocytopenia (n=35). The sensitivity, specificity, PPV and NPV when MPV ≥8.8 fL indicating over-destructive thrombocytopenia were 77%, 89%, 89% and 77%, respectively. MPV is useful for differentiating the cause of thrombocytopenia. The value of MPV ≥8.8 fL has acceptable sensitivity and specificity for diagnosis of over-destructive thrombocytopenia.

Keywords: Thrombocytopenia; mean platelet volume; over-destructive thrombocytopenia; underproductive thrombocytopenia.

Conflict of interest statement

Conflict of interest: the authors declare no potential conflict of interest.

Figures

Figure 1.
Figure 1.
Receiving Operating Characteristics curve of mean platelet volume to differentiate between underproductive bone marrow and over-destruction causes of thrombocytopenia.

References

    1. Stasi R. How to approach thrombocytopenia. Hematol Am Soc Hematol Educ Program 2012;2012:191-7.
    1. Neunert C, Lim W, Crowther M, et al. The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia. Blood 2011;117:4190-207.
    1. Wada H, Thachil J, Di Nisio M, et al. Guidance for diagnosis and treatment of disseminated intravascular coagulation from harmonization of the recommendations from three guidelines. J Thromb Haemost 2013;11:761-7.
    1. Leader A, Pereg D, Lishner M. Are platelet volume indices of clinical use? A multidisciplinary review. Ann Med 2012;44:805-16.
    1. Bessman JD, Gilmer PR, Gardner FH. Use of mean platelet volume improves detection of platelet disorders. Blood Cell 1985;11:127-35.
    1. Levin J, Bessman JD. The inverse relation between platelet volume and platelet number. Abnormalities in hematologic disease and evidence that platelet size does not correlate with platelet age. J Lab Clin Med 1983;101:295-307.
    1. Bowles KM, Cooke LJ, Richards EM, Baglin TP. Platelet size has diagnostic predictive value in patients with thrombocytopenia. Clin Lab Haem 2005;27:370-3.
    1. Abe Y, Wada H, Tomatsu H, et al. A simple technique to determine thrombopoiesis level using immature platelet fraction (IPF). Thromb Res 2006;118:463-9.
    1. Kaito K, Otsubo H, Usui N. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol 2005;128:698-702.
    1. Ntaios G, Papadopoulos A, Chatzinikolaou A. Increased values of mean platelet volume and platelet size deviation width may provide a safe positive diagnosis of idiopathic thrombocytopenic purpura. Acta Haematol 2008;119:173-7.
    1. Negash M, Tsegaye A, Medhin AG. 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. BMC Hematology 2016;16:1-8.
    1. Chandra H, Chandra S, Rawat A, Verma SK. Role of mean platelet volume as discriminating guide for bone marrow disease in patients with thrombocytopenia. Int J Lab Hematol 2010;32:498-505.
    1. Pathepchotiwong K., Dhareruchta P, Adirojananon W. Platelet parameter in healthy subjects analyzed by automation analyzer. Thai J Hematol Transf Med 2001;11:93-100.
    1. Numbenjapon T, Mahapo N, Pornvipawee R, et al. A prospective evaluation of normal mean platelet volume in discriminating hyperdestructive thrombocytopenia from hypoproductive thrombocytopenia. Int J Lab Hem 2008;30:408-14.
    1. Adly AAM, Ragab IA, Ismail EAR, Farahat MM. Evaluation of the immature platelet fraction in the diagnosis and prognosis of childhood immune thrombocytopenia. Platelets 2015;26:645-50.
    1. Fenaux P, Haase D, Sanz GF, et al. Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2014;25:iii57-69.
    1. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15:e538-48.
    1. Green R, Datta Mitra A. Megaloblastic Anemias: Nutritional and Other Causes. Med Clin North Am 2017;101:297-317.
    1. Noris P, Klersy C, Gresele P, et al. Platelet size for distinguishing between inherited thrombocytopenias and immune thrombocytopenia: a multicentric, real life study. Br J Haematol 2013;162:112-9.

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