Platelet indices and angiogenesis markers in hypertensive disorders of pregnancy

INTRODUCTION

Activated platelets exert a key role in the pathogenesis of preeclampsia (PE). There is evidence of distinctive patterns of platelet indices in PE in comparison to healthy pregnancies, therefore these indices can be potential tools for PE detection, risk stratification, and management. Considering the vascular aspects of its pathophysiology, PE is characterized by the increased levels of soluble FMS-like tyrosine kinase-1 (sFlt-1) an antiangiogenic factor, and reduced placental growth factor (PlGF), a proangiogenic factor. This study aimed to assess the platelet indices in hypertensive disorders of pregnancy (HDP) and its correlation with angiogenesis-related biomarkers.

METHODS

The groups for the study were: control (n = 114); gestational hypertension; (n = 112), and PE (n = 42). The platelet indices included were platelet counts (PLT-I and PLT-F), mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), platelet large cell ratio (P-LCR), and immature platelet fraction (IPF# and IPF%). Serum levels of sFlt-1 and PlGF were assessed.

RESULTS

PLT-I, PLT-F, and PCT% were lower in PE, while MPV, PDW, P-LCR, IPF%, and IPF# were increased. The parameter MPV presented the best performance for the discrimination of PE. There was a moderate positive correlation between sFlt-1 levels and MPV, PDW, and P-LCR.

CONCLUSION

Platelet indices can be potentially applied as additional tools for the diagnosis and management of HDP. Activated platelets may act as an extra source of sFlt-1 in PE.

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. The younger (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 with controls (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) and controls (II). The cases included patients of diabetes mellitus (DM) of a 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 was diabetics 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) and controls (II). The average MPV (9.4-12.3 femtolitre) in diabetics was 12.089±1.450 fL as compared to the controls where it was 9.464±1.424 fL with a statistically significant p-value of 0.001. PDW among 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% among the cases, in comparison to the mean P-LCR among the 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.

The impact of platelet indices on ischemic stroke: a Mendelian randomization study and mediation analysis

Introduction

Platelet indices (PIs) are hematological parameters that indicate the number, morphology, and activation of platelets. Although some clinical trials suggest an association between PIs and the risk of stroke, the lack of robust evidence is attributed to confounding effects and reverse causation.

Objective

This study aimed to evaluate the association between PIs and stroke risk through Mendelian randomization (MR) while exploring the mediating effect of blood pressure in this association.

Methods

We identified genetic variants associated with PIs, including platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and platelet crit (PCT), in the UK Biobank (n = 350,474). Relevant genome-wide association studies were utilized to gather summary statistics pertaining to the traits of interest. We primarily used the inverse-variance weighted analysis to obtain estimates for individual causal power.

Result

We observed a positive correlation between genetically predicted increases in PCT levels with the stroke onset [PCT: OR (95%CI) = 1.113(1.047, 1.183), p < 0.001]. However, no significant causal relationship was found between PLT, PDW, and MPV and the risk of stroke [PLT: OR (95%CI) = 1.037(0.979, 1.098), p = 0.221; PDW: OR (95%CI) = 0.973(0.923, 1.024), p = 0.294; MPV: OR (95%CI) = 0.990(0.945, 1.038), p = 0.675]. Multivariable MR analyses and mediation analysis found that the proportion mediated by systolic blood pressure (SBP) is 23.71% [95%CI (10.85-33.31%)] and the proportion mediated by diastolic blood pressure (DBP) is 28.09% [95%CI (12.92-39.63%)].

Conclusion

This large MR study presents evidence for the potential causal relationship between the PCT level and the risk of ischemic stroke, which might be mediated by blood pressure.

Clinical utility of haematological inflammatory biomarkers in predicting 30-day mortality in hospitalised adult patients with COVID-19

Coronavirus disease 2019 (COVID-19) is a multisystem disease affecting respiratory, cardiovascular, gastrointestinal, neurological, immunological and haematological systems. The most important indices that have been studied are platelet (PLT) indices in addition to the PLT count and red blood cell distribution width (RDW). This retrospective study included 95 patients with COVID-19 and was conducted at the Hospital Isolation, Scientific and Medical Research Centre and Clinical Pathology Department at Zagazig University Hospitals, Egypt over 6 months from March to August 2021. All patients on admission had a full blood count, which included white blood cell (WBC) count, haemoglobin, RDW, PLT count and its indices in addition to PLT-to-WBC ratio (PWR) and PLT-to-lymphocyte ratio (PLR), which were calculated for all the study patients. There were significant linear correlations for higher levels of the PLR, PWR and RDW and mortality rate (p = 0.03, p < 0.001 and p < 0.001 respectively). Moreover, on multivariable analysis the RDW, PLT count and PWR levels were independent prognostic predictors for mortality with a hazard ratio [HR] of 1.25 (95% confidence interval [CI] 1.09-1.44, p = 0.002), 1.00 (95% CI 0.99-1.00, p = 0.03) and 2.3 (95% CI 1.21-4.48, p = 0.01) respectively. The RDW and PLT indices are accessible predictors that can be valuable prognostic factors for survival assessment and risk stratification of COVID-19.

Platelet indices as an accouterment for monitoring short-term glycemic levels and as an economical alternative to HbA1c

Background

India is facing a galloping diabetes epidemic with an estimated 62 million patients and is projected to explode beyond 85 million by the year 2030. There is platelet dysfunction with platelet hyper-reactivity in diabetes mellitus.

Aim

To assess for any correlation between HbA1c levels with various platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR).

Material and Methods

Applying inclusion and exclusion criteria, diabetes mellitus patients have undergone detailed history, clinical examination, and laboratory investigations. Data is statistically analyzed for levels of HbA1c and their correlation to platelet indices.

Results

58.7% study population is with HbA1c levels of more than 8%. In patients with normal range HbA1c levels between 4-6%, the MPV, PDW, and P-LCR are found to be 9.9 ± 0.97 fl, 10.84 ± 2.08 fl, and 23.75 ± 7.99%, respectively. In patients with HbA1c levels of 6.1 to 7%, the MPV, PDW, and P-LCR are found to be 10.22 ± 1.04 fl, 11.79 ± 1.8 fl, and 26.36 ± 7.05%, respectively. In patients with HbA1c levels of 7.1 to 8%, the MPV, PDW, and P-LCR values are found to be 10.21 ± 1.06 fl, 12.03 ± 2.52 fl, and 26.65 ± 8.05%, respectively. In patients with poor glycemic control with HbA1c levels more than 8%, the MPV, PDW, and P-LCR are found to be 10.64 ± 1.1 fl, 12.81 ± 2.61 fl, and 30.26 ± 8.24%, respectively.

Conclusion

In type 2 diabetes mellitus patients, HbA1c is positively correlated with platelet indices.

Platelet Abnormalities in Children with Laboratory-Confirmed Influenza

BACKGROUND

The role of platelets in the immune response against influenza has been raised, and a diagnostic or prognostic value of platelet parameter abnormalities, including platelet count (PLT), or mean platelet volume (MPV), has been suggested. The study aimed to analyze the prognostic value of platelet parameters in children hospitalized due to laboratory-confirmed influenza.

METHODS

We retrospectively verified the platelet parameters (PLT, MPV, MPV/PLT, and PLT/lymphocyte ratio regarding the influenza complications (acute otitis media, pneumonia, and lower respiratory tract infection-LRTI), and the clinical course (antibiotic treatment, tertiary care transfer, and death).

RESULTS

An abnormal PLT was observed in 84 out of 489 laboratory-confirmed cases (17.2%, 44 thrombocytopaenia cases, and 40 thrombocytoses). Patients' age correlated negatively with PLT (rho = -0.46) and positively with MPV/PLT (rho = 0.44), while MPV was not age-dependent. The abnormal PLT correlated with increased odds of complications (OR = 1.67), including LRTI (OR = 1.89). Thrombocytosis was related to increased odds of LRTI (OR = 3.64), and radiologically/ultrasound-confirmed pneumonia (OR = 2.15), mostly in children aged under 1 year (OR = 4.22 and OR = 3.79, respectively). Thrombocytopaenia was related to antibiotic use (OR = 2.41) and longer hospital stays (OR = 3.03). A lowered MPV predicted a tertiary care transfer (AUC = 0.77), while MPV/PLT was the most versatile parameter in predicting LRTI (AUC = 0.7 in <1 yo), pneumonia (AUC = 0.68 in <1 yo), and antibiotic treatment (AUC = 0.66 in 1-2 yo and AUC = 0.6 in 2-5 yo).

CONCLUSIONS

Platelet parameters, including PLT count abnormalities and MPV/PLT ratio, are related to the increased odds of complications and a more severe disease course, and may add important data in assessing pediatric influenza patients, but should be interpreted cautiously due to age-related specificities.

The Association between Placental Abruption and Platelet Indices

Objective: Placental abruption (PA) is an obstetric emergency. This study investigated the use of platelet indices in PA in its early stages to determine if it could aid in diagnosis. Materials and Methods: Sixty-two pregnant women with PA and 130 pregnant women who delivered due to idiopathic preterm delivery were included in this case-control study. Blood samples including platelet indices, biochemical, and coagulation parameters were obtained before cesarean section. Maternal and neonatal outcomes were recorded. Results: There was no significant difference between the groups as to hemoglobin, hematocrit, and white blood count. Platelet, mean platelet volume (MPV), and platelet to lymphocyte ratio (PLR) were significantly lower, platelet distribution width (PDW) was significantly higher in the PA patients. Conclusion: In the current study, MPV and PLR were lower and PDW was higher in PA patients. These parameters may be useful in assessment of PA.

Correlation of leucocyte and platelet indices in patients with type 2 diabetes mellitus with microvascular complications at a tertiary care hospital in south India - A prospective cross-sectional study

Objective. The present study was directed to assess the correlation between leukocyte and platelet indices and microvascular complications in patients with type 2 diabetes mellitus (T2DM). Methods. A prospective cross-sectional study was conducted between January 2020 and May 2021 at a tertiary healthcare center. Sixty T2DM patients, who fulfilled the inclusion and exclusion criteria, were included into the study and divided into 2 groups: T2DM patients with microvascular complications and T2DM patients without vascular complications. Clinical history was taken and examinations (routine complete blood count) were done to obtain platelet indices, neutrophillymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and lymphocyte-monocyte ratio (LMR) were obtained and tabulated. A correlation was statistically analyzed from the obtained data, p value <0.05 was considered to be statistically significant. Results. From the patients with microvascular complications, 18 cases suffered from retinopathy and nephropathy. Majority of the participants suffered from moderate non-proliferative retinopathy. The creatine median and absolute neutrophil count (ANC) were significantly higher in T2DM patients with microvascular complications (p<0.0001 and p<0.0054, respectively) compared to T2DM patients without vascular complications. No significant correlation was found between platelet indices, NLR, PLR with regard to fasting blood sugar, post prandial blood sugar, HbA1C in T2DM patients. Conclusions. Since no significant correlation was found between the different platelet indices and microvascular complications, it is evident that these markers cannot be used as the predictors of microvascular complications in T2DM patients.

Assessment of the utility of platelet indices to diagnose clinical benign prostatic hyperplasia in dogs

Introduction

Platelet indices changes in severely ill people and in dogs with inflammation are compatible findings. This study aimed to compare platelet indices between dogs with clinical benign prostatic hyperplasia (BPH) and healthy controls. Additionally, to determine whether there is a correlation between the relative prostatic size (S _rel) and the platelet indices in BPH dogs.

Methods

Thirty-five adult intact male dogs of different breeds were allocated to the experimental groups: dogs with clinical BPH (groups A; n = 24; median age of 6 years; the median weight of 8.50 kg) and healthy dogs (group B; n = 11; median age 5.50 years; the median weight of 7.00 kg) based on physical examination, clinical signs, and S _rel detected by ultrasonographic findings. The individual prostatic volume (IPV) was divided by the expected prostatic volume (EPV) to determine the relative prostatic size in dogs over 4 years old. Platelet indices were compared between the two groups, and a correlation between S _rel and these indices was calculated.

Results

The median S _rel of dogs in group A was significantly higher (P = 0.001), and the mean plateletcrit (PCT) was significantly lower (P = 0.003) compared with those in group B. S _rel showed a significant negative correlation with PLT and PCT (r = -0.388; P = 0.02 and r = -0.402; P = 0.01). Receiver operating characteristic (ROC) analysis showed PLT and PCT thresholds for estimating S _rel > 1 with 75% and 87.5% sensitivity and 71.82 and 63.64% specificity.

Discussion

The findings of this study support the use of platelet indices like PLT and PCT to detect clinical BPH in dogs. However, more research is needed to confirm their utility in conjunction with other previously described diagnostic factors.

Role of variation in platelet indices in pregnancy-related pathological complications and the prediction of postpartum hemorrhage: a case-control study

BACKGROUND

Pregnancy-related pathological complications (PPCs) increase the risk of postpartum hemorrhage (PPH), Platelet activation and destruction are expected outcomes of PPCs. This study sought to compare the platelet indices of non-pregnant (NP) child-bearing aged women, healthy pregnant (HP) women, and women with PPCs, and investigate the use of these indices in PPH prediction.

METHODS

This retrospective clinical study included 260 NP child-bearing aged women and 119 pregnant women. Of the 119 pregnant patients, 69 had HPs and 50 suffered from PPCs. Further, 50 patients delivered with PPH. We compared the platelet counts (PCs), mean platelet volumes (MPVs), platelet distribution widths (PDWs), plateletcrits (Pcts), MPV ratios (PC/MPV and Pct/MPV), alpha angles (angles), and maximum amplitudes (MAs) of the patients using Sysmex XN10 hematology analyzer and TEG 5000 Hemostasis analyzer system, respectively.

RESULTS

With the exception of PDW, there were significant differences in the platelet parameters of the NP, HP, and PPC patients (P<0.05). The intergroup comparison results showed that the NP patients differed significantly from the HP and PPC patients in terms of age, MA, PC, Pct, and Pct/MPV (P<0.0125). Further, the HP and PPC patients differed significantly in terms of Pct, MPV, PC/MPV, and Pct/MPV (P<0.0125). Additionally, the univariate analysis showed that in the PPC patients, low MPV values were strongly related to PPH [odds ratio (OR) =0.012, P=0.003; OR =0.331, P=0.047].

CONCLUSIONS

Women with PPCs had significantly lower PC, Pct, PC/MPV and Pct/MPV values, but significantly higher MA and MPV values. PPHs were strongly related to PPC and low MPV values. A timely accurate diagnosis and evaluating MPV values may be useful in the prediction of PPH.

Study of platelet indices and their role in evaluation of thrombocytopenia

Background

Thrombocytopenia may result from mechanisms such as marrow hypoplasia, increased destruction of platelets, and splenic sequestration. The gold standard method for discriminating the causes of thrombocytopenia is bone marrow examination, but it is invasive and expensive. Therefore, an alternative method should be introduced as a first-line diagnostic procedure. Of late, the automated blood cell analyzer has made it possible to assess the cause of thrombocytopenia through various machine-derived parameters, known as platelet indices, which include the mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT), which are provided as a part of routine complete blood count.

Objectives

The objectives of the present study are to study the variation and effectiveness of platelet indices in establishing the etiology of thrombocytopenia.

Method

An observational, prospective, and comparative study was conducted on 134 patients with thrombocytopenia, and 67 cases were taken as the normal group. The study group was classified into two groups: hypo-productive and hyper-destructive. Platelet indices were recorded and compared in the two groups along with the normal group.

Results

The mean platelet count (10^3 μL) in the normal, hypo-productive, and hyper-destructive groups was 232.03 ± 74.84, 73.00 ± 36.52, and 68.28 ± 38.24, respectively. The MPV and mean PCT in the normal, hypo-productive, and hyper-destructive groups were 9.46 ± 1.68fL, 8.99 ± 1.49fL, and 11.35 ± 1.35fL and 0.22 ± 0.06%, 0.07 ± 0.04%, and 0.08 ± 0.05%, respectively. The mean PDW in the normal, hypo-productive, and hyper-destructive groups was 15.66 ± 1.76fL, 17.63 ± 1.01fL, and 18.32 ± 1.10fL, respectively.

Conclusion

In the present study, platelet indices such as MPV, PCT, and PDW are higher in the hyper-destructive group and may discriminate hyper-destructive from hypo-productive causes of thrombocytopenia.

Reference interval of platelet counts and other platelet indices in apparently healthy blood donors in North India according to Clinical and Laboratory Standards Institute guidelines: Need to redefine the platelet count cutoffs for repeat plateletpheresis donation?

BACKGROUND

In clinical practice, laboratory results are of great importance for the diagnosis and treatment. Reference intervals of different parameters aid health-care professionals in the interpretation of results. There are very few studies on reference intervals from India. This prospective study was conducted to determine the reference intervals for platelet count (PLT) and PLT indices; mean PLT volume (MPV), PLT distribution width (PDW), and PLT large cell ratio (P-LCR). These values can be obtained as a part of a routine complete blood count (CBC) and have diagnostic and prognostic significance in certain diseases. PLT count is an important criterion for the selection of donors for repeat plateletpheresis donation.

MATERIALS AND METHODS

Sixteen hundred and thirty-four first-time healthy volunteer plateletpheresis donors were enrolled for the study. CBC was done, values of PLT, MPV, PDW, and P-LCR were noted, and the results were analyzed. The 95% of the reference distribution was estimated using the 2.5th and 97.5th percentiles following Clinical and Laboratory Standards Institute guidelines. Adverse donor reactions, if any and quality parameters of single donor PLTs (SDP) were also studied.

RESULTS

Reference range values of PLT, MPV, PDW, and P-LCR were 137,825-355,175/μl, 8.1-13.9/fl, 9.1-22.5/fl, and 11.7%-52.9%, respectively, and compared well with other published studies from India. It was observed that reference values of PLT count obtained in the study were lower than reference values that are currently used in most laboratories (150,000-450,000/μl) in India.

CONCLUSION

Based on our results, we are of the opinion that the PLT count cutoffs for repeat plateletpheresis donation may need to be revised downwards for our country which would also mitigate the scarcity of apheresis donors.

Are platelet indices promising ratios for predicting pediatric septic shock prognosis?

OBJECTIVES

The aim of the present study was to determine the prognostic value of thrombocytopenia, platelet indices (MPV/PLT and PDW/PLT) in children with septic shock.

BACKGROUND

Septic shock is one of the major causes of mortality among children worldwide.

METHODS

A retrospective analysis was made of children admitted to the pediatric intensive care unit between November 2010 and December 2019. Two hundred four children were included; they were diagnosed with septic shock according to the international pediatric sepsis consensus conference criteria. The MPV/platelet ratio and PDW/platelet ratios were estimated as the MPV and PDW values divided by the platelet count on the first three days of hospitalization. The clinical outcome was 28-day mortality.

RESULTS

MPV/PLT and PDW/PLT ratios were found to be significantly higher in the non-survivors than survivor (p≤0.001). In the multivariate logistic regression analysis, higher MPV/platelet ratios at 72h (OR: 7.41; 95% CI: 1.25-43.7; p=0.027) and PDW/platelet ratios at 72h (OR: 2.9; 95% CI: 1.13-7.50; p=0.027) were significant risk factors for mortality.

CONCLUSIONS

Platelet indices are useful laboratory parameters in septic shock. MPV/PLT and PDW/PLT ratios can be promising reliable markers for 28-day mortality in children with septic shock (Tab. 4, Fig. 1, Ref. 29).

Is there any relationship between platelet indices and myocarditis in children?

BACKGROUND

Platelet indices are used to evaluate platelet activation and function which change in inflammatory diseases. We hypothesise that platelet indices such as plateletcrit, mean platelet volume, and platelet distribution width may be more useful as prognostic indicators for myopericarditis in children.

METHODS

A total of 60 children were included in this study. Group 1 consists of children with myopericarditis, Group 2 is those with respiratory infections, and Group 3 consists of control group children of similar age and gender with the patient groups. Complete blood count parameters, C-reactive protein, and troponin values of the whole study group were recorded. Myopericarditis was diagnosed based on acute chest pain, dyspnea, palpitations, heart failure signs, arrhythmia symptoms and ST/T wave change, low voltage, supraventricular tachycardia/ventricular tachycardia on ECG, or elevated troponin T/troponin I levels or functional abnormalities on echocardiography. A comparison of the platelet indices made during diagnosis and 2 weeks after treatment was done for the myopericarditis patients.

RESULTS

There was no statistically significant difference in platelet indicies values. However, the increase in platelets and plateletcrit values after the treatment of myopericarditis was statistically significant. This study pointed out that there was a negative correlation between platelet-plateletcrit values and the troponin I-C-reactive protein.

CONCLUSION

We found that platelet count and plateletcrit values increased after treatment. This is important as it is the first study in children to investigate the possible role of platelet indications for myopericarditis in children.

Predictive Role of Platelet-Associated Indices on Admission and Discharge in the Long-Term Prognosis of Acute Coronary Syndrome Patients

Our study aimed to investigate the association between platelet indices and their in-hospital change and long-term prognosis in acute coronary syndrome (ACS). Data from a randomized controlled trial (NCT02927808) recruiting ACS patients were analyzed (survival analysis). The examined variables were platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW), and plateletcrit (PCT) on admission and discharge, as well as their alteration during hospitalization. The primary endpoint was major adverse cardiac events (MACE) (cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke or hospitalization for unstable angina) and all-cause mortality, while secondary endpoints were all-cause hospitalization and bleeding events. The study included 252 patients with a follow-up of 39 (28-45) months. In the univariate analysis, MACE was associated with discharge PC [hazard ratio (HR) 2.20, 95% confidence interval (CI) 1.10-4.40], discharge MPV (HR 0.48, 95% CI 0.25-0.94), and in-hospital PC difference (HR 0.25, 95% CI 0.13-0.51). In the multivariable analysis, only in-hospital PC decrease correlated with lower MACE incidence (adjusted HR .27, 95% CI 0.14-0.54) and lower all-cause hospitalization risk (adjusted HR 0.36, 95% CI 0.19-0.68). PC reduction during hospitalization for ACS is an independent predictor of better prognosis.

Platelet Indices be a New Biomarker for Periodontal Disease

Background:

Platelets play an important role in inflammation and hemostasis. Periodontitis, a chronic inflammatory disease, is linked to an increase in platelet activation leading to increased risk for atherosclerosis and cardiovascular diseases.

Aim:

The aim was to evaluate whether platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], and plateletcrit [PCT]) can be a biomarker for determining the severity of periodontal disease and to assess the relation between platelet indices in patients with periodontitis and healthy controls.

Materials and Methods:

The study included 3 groups – moderate periodontitis, severe periodontitis, and systemically healthy controls without periodontitis. Clinical parameters recorded were clinical attachment level and probing pocket depth and venous blood samples were drawn for the analysis of MPV, PDW, and PCT.

Results:

ANOVA test with post hoc Tukey's test was used to compare among 3 groups. Statistical analysis of platelet indices was done using sample t-test. The mean values of MPV, PDW, and PCT gradually increased from normal to severe periodontitis.

Conclusion:

Periodontitis, a chronic inflammatory process, causes not only increase in the quantity of platelets but also causes platelet activation which leads to change in platelet size, platelet shape, and platelet aggregation. As periodontitis causing platelet activation which seems to be a contributing factor in the development of cardiovascular diseases.

The Relationship between Platelet Indices and Ultrasound, Clinical, Laboratory Parameters of Disease Activity in Patients with Rheumatoid Arthritis

(1) Background: A proper assessment of disease activity is crucial for the management of a patient with rheumatoid arthritis (RA). Platelets seem to be involved in joint inflammation pathophysiology. Platelet indices (PIs) are markers of platelet activation, and include platelet count (PC), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). The purpose of the study was to assess the relationship between PIs and disease activity markers, both systemic (clinical, laboratory) and local (ultrasound, US), in patients with RA; (2) Methods: The study group consisted of 131 consecutive RA patients. The following assessments were performed: joint counts, Disease Activity Score (DAS28), complete blood cell counts, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and US of 24 small joints; (3) Results: Mean values of PIs remained within the normal reference ranges. Values of PC, PCT, PDW were significantly associated with disease activity markers, both clinical (DAS28, joint counts) and laboratory (CRP, ESR). In patients with high disease activity, PC, PCT were significantly higher and PDW lower. PC was positively correlated with Power Doppler US (PDUS) score. In patients with features of RA severity (antibodies positivity, extra-articular manifestations) PC and PCT were positively associated with all US parameters (Grey Scale US, PDUS, Global scores); (4) Conclusions: In patients with RA, PC and PCT may serve as positive disease activity markers and PDW may serve as a negative marker. PIs may be used as reliable, inexpensive markers of RA systemic activity; they may also serve as markers of local inflammation in the joints affected by RA.

Mean Platelet Volume and Platelet Volume Distribution Width in Canine Parvoviral Enteritis

Bacterial translocation from the damaged intestinal tract, reported in canine parvoviral (CPV) enteritis, is thought to be responsible for the systemic inflammatory response resulting from coliform septicemia, which could ultimately progress to septic shock and death. Alterations in platelet indices, specifically mean platelet volume (MPV), is a consistent finding in critically ill people and dogs with and without sepsis. Increased MPV has been reported to be an indirect indicator of platelet activation and of bone marrow response in people and dogs with sepsis. The study aim was to compare admission MPV and platelet volume distribution width (PVDW) in dogs with CPV enteritis to that of healthy aged-matched control dogs. Forty-eight dogs with CPV enteritis and 18 healthy age matched control dogs were included. CPV infection was confirmed with electron microscopy and concurrent blood-borne infections were excluded using PCR. EDTA whole blood samples were analyzed on an automated cell counter, ADVIA 2120, within 30-60 min from collection. There was no significant difference for platelet count between the groups. The MPV for CPV infected dogs (median: 14.0; IQR: 12.2–15.1) was significantly higher compared to controls (11.3; IQR: 10.3–13.1, P = 0.002). The PVDW for CPV infected dogs (66.9; IQR: 64.2–68.8) was significantly higher compared to controls (63.3; IQR: 60.2–65.1, P < 0.001). These findings suggest that significant platelet activation is present in dogs with CPV enteritis which may play a role in the disease outcome, similar to people with sepsis. Further studies are required to investigate the prognosticating ability of MPV in dogs with CPV enteritis.

Platelet Activation and Inflammation in Patients with Papillary Thyroid Cancer

Background: The primary endpoint was to analyze the preoperatory inflammatory markers and platelet indices in papillary thyroid cancer (PTC) patients compared with patients with benign thyroid pathology. The secondary endpoints were to analyze the relationship between these markers and the pathological features of PTC and to compare their pre- and postoperative levels in PTC patients. Methods: In this retrospective case-control study, we analyzed the files of 1183 patients submitted to thyroidectomy between January 2012 and December 2018. A total of 234 patients with PTC (mean age 51.54 ± 13.10 years, 84.6% females) were compared with an age-, gender- and BMI-matched control group of 108 patients with histologic benign thyroid disorders. Results: PTC patients had higher platelet count (PLT) (p = 0.011), plateletcrit (PCT) (p = 0.006), neutrophil (p = 0.022) and fibrinogen (p = 0.005) levels. Subgroup analysis showed that PTC females had higher PLT (p = 0.006), PCT (p < 0.001) and erythrocyte sedimentation rate (ESR) (p = 0.005), while males had higher neutrophil (p = 0.040) levels. Papillary thyroid cancer patients under 55 years had higher PLT (p < 0.001) and PCT (p = 0.010), while patients over 55 years had higher mean platelet volume (p = 0.032), neutrophil-to-lymphocyte ratio (p = 0.013), ESR (p = 0.005) and fibrinogen (p = 0.019) levels. Preoperative values for platelet indices and inflammatory markers were similar to the postoperative determinations in PTC patients. Fibrinogen (AUROC = 0.602, p = 0.02; cut-off = 327.5 mg/dL, Se = 53.8%, Sp = 62.9%) and PLT (AUROC = 0.584, p = 0.012; cut-off = 223.5 × 10³/mm³, Se = 73.1%, Sp = 42.6%) were independent predictors of the presence of PTC. Conclusions: Our data show that fibrinogen and platelet count could be promising, inexpensive, independent predictors for the presence of PTC when compared with benign thyroid disorders.

Platelet indices in patients with type 2 diabetes mellitus undergoing percutaneous coronary intervention

CONTEXT

Platelet indices change in relation to cardiovascular risk factors, including type 2 diabetes mellitus (T2DM). An increase of platelet indices over time in patients undergoing percutaneous coronary intervention (PCI) could be a predictor of mortality.The objective of this study was to assess differences in platelet indices in patients with and without T2DM undergoing PCI, prior and more than one month after the procedure.

SUBJECTS AND METHODS

In this retrospective observational study, patients undergoing PCI were included. Data were extracted from PCI Registry of the Emergency Institute for Cardiovascular Diseases and Transplantation of Tirgu Mures, Romania.

RESULTS

Of the 718 patients included in the study, 222 (30.9%) had T2DM; 61% of patient underwent PCI for SCAD, the rest for NSTE-ACS or STEMI. Prior to PCI, MPV, PDW and P-LCR were not higher in T2DM patients irrespective of the indication for PCI. At a follow-up time of 69 (46-98) days, platelet indices were not different between TD2M+ and T2DM-, except from MPV (11.0 vs. 10.6, p=0.02) which were higher in TD2M patients with SCAD. Intraindividual variability of platelet indices was not different in diabetics, but MPV, PDW and platelet count decreased over time (3.5% and 8.4% respectively) in diabetics with STEMI (p=0.02).

CONCLUSIONS

Platelet indices were not higher in patients with T2DM undergoing PCI, but we observed an important variation in platelet indices in diabetics after STEMI related PCI.

The Usefulness of Platelet Distribution Width and Platelet Distribution Width to Lymphocyte Ratio in Predicting Severity and Outcomes in Patients with Snakebite

INTRODUCTION

Tissue damage, inflammatory response, and hematologic abnormalities may occur in snakebite envenomation. This study aimed to evaluate the predictive ability of platelet distribution width (PDW) and platelet distribution width to lymphocyte ratio (PDWLR) in the severity and outcome of envenomation in patients with snakebites in the emergency department (ED).

METHODS

All adult patients admitted to the ED after a snakebite were retrospectively evaluated. Patients were classified according to the severity of envenomation. The relationship between the PDW and PDWLR and envenomation severity and patient outcomes was analyzed. Multivariate logistic regression analysis was performed to determine the predictors of severe envenomation. Results were presented as 95% CIs with odds ratios. Statistical significance was accepted at P<0.05.

RESULTS

Envenomation was classified as none/minimal in 42 patients and moderate/severe in 29. PDW and PDWLR were significantly higher in the moderate/severe group (P=0.016 and P<0.001, respectively). Cut-off values of 16.5 for PDW and 6.15 for PDWLR were related to more severe envenomation (area under the curve 0.67, 95% CI 0.55-0.78 and area under the curve 0.85, 95% CI: 0.74-0.92, respectively). Blood product replacement, thrombocytopenia, hematologic abnormality, advanced local findings, compartment syndrome/fasciotomy, antivenom dosing, and moderate/severe envenomation were associated with PDWLR >6.15 (P<0.05). In multivariate analysis, PDWLR (odds ratio 1.19 [95% CI 1-1.4]; P=0.04) was an independent predictor of severe envenomation.

CONCLUSIONS

Higher PDW and PDWLR were associated with severe envenomation in patients with snakebites in the ED. PDWLR may be used as a predictor of severe envenomation and adverse outcomes.

White blood cells and platelet profiles of diabetic patients at University of Gondar specialized referral hospital: A comparative cross-sectional study

BACKGROUND

Altered level of many hematological parameters such as white blood cells (WBC) and platelet function has been observed in diabetes mellitus (DM) patients. Therefore, this study aimed to determine the WBC and platelet profiles and their association with anthropometric measurement and blood pressure in DM patients and healthy controls.

METHOD

A comparative cross-sectional study was conducted on a total of 246 participants at the University of Gondar Specialized Referral Hospital. Venous blood with K₂ EDTA anticoagulant was drawn and analyzed by using Sysmex KX21N hematology analyzers for WBC and platelet parameters. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 20. Results were presented as frequency and mean ± standard deviation (SD). The independent sample t test was used to compare quantitative variables between DM and control groups. The bivariate (spearman's rank) correlation was used to analyze continuous variables. A p-value ˂ 0.05 was considered as statistically significant.

RESULTS

The mean platelet count was significantly higher among diabetics (252.77 ± 77.7) compared to non-diabetic controls (208.22 ± 68), p < 0.001. Similarly, the total WBC count was higher among DM patients (6.95 ± 2.23) than in the controls (6.15 ± 1.95), p = 0.04. A significant negative correlation was also found between neutrophil and duration of illness in DM patients. Besides, there is a significant positive correlation between WBC and lymphocyte number with systolic blood pressure (SBP) in DM patients.

CONCLUSION

Platelet and WBC count were significantly higher in DM patients than in the controls. Therefore, routine screening and profile checking of those abnormal indices is recommended to minimize DM-related complications.

A hospital based cross-sectional study on platelet parameters in adult patients with dengue, its serological subgroups, and controls

Our objective was to analyze if there was a significant relationship between platelet parameters (PLT, MPV, PDW, P-LCR, PCT) among dengue, its serological subgroups and controls. Serologically proven adult patients with dengue {(n = 238) (NS1 positive = 218, IgM positive = 14, NS1 & IgM positive = 6)} and age- and gender-matched controls (n = 254) were included. The MPV, PDW and P-LCR were significantly higher, and PLT and PCT were significantly lower in cases compared with controls. Cases as well as controls showed a positive correlation between PLT and PCT, both parameters individually showed negative correlation with MPV, PDW, P-LCR. MPV, PDW and P-LCR showed positive correlation with each other. The results were similar in the serological subgroups. Comparison of our results with other studies points toward an overall hyperdestructive etiology for thrombocytopenia in dengue. There were two subgroups of cases based on the severity of thrombocytopenia. The mean/median value of all the platelet parameters was lesser in the ≤20k group than the >20k group, except for PDW, which was high although not statistically significant. Suppression of megakaryopoiesis with concomitant immune destruction of platelets in severe dengue could explain low MPV and P-LCR with a high PDW in view of the presence of microthrombocytes as a result of immune destruction. Although an overall hyperdestructive mechanism contributes to thrombocytopenia in dengue, regular monitoring of the platelet indices could reflect the status of megakaryopoiesis and thrombokinetic axis, thus aiding easy determination of pathophysiology and treatment.

Role of dyslipidemia in the development of early-onset preeclampsia

Preeclampsia (PE) is a gestational-related disease presented with hypertension, peripheral edema, and proteinuria after 20 weeks of gestation. In PE, there are various metabolic changes like dyslipidemia. In addition, both PE and dyslipidemia are associated with changes of platelet indices. Thus, objective of the current study was to illustrate the potential role of dyslipidemia and platelet changes in pregnant women with PE. This case–control study involved 37 preeclamptic pregnant women as compared to 24 healthy pregnant women as controls. Blood pressure profile, lipid profile, proteinuria, and platelet indices were measured. Blood pressure profile was higher in preeclamptic pregnant women as compared to the controls (P < 0.01). There was a significant dyslipidemic status in preeclamptic pregnant women compared with the controls (P < 0.01). Platetetcrit (PCT) and platelet count (PC) were lower in preeclamptic pregnant women compared with the controls (P = 0.001). On the other hand, platelet distribution width (PDW), mean platelet volume (MPV), and platelet-large cell ratio (P-LCR) were higher in the pregnant women with PE as compared with the controls (P = 0.001). PCT and PC were insignificantly linked, while P-LCR, MPV and PDW were significantly correlated with total cholesterol, triglyceride, low-density lipoprotein (LDL)/high-density lipoprotein (HDL) ratio, systolic blood pressure, DBP, and MAP in preeclamptic patients compared with women of normal pregnancy. Both dyslipidemia and alterations in the platelet indices are correlated with blood pressure profile in PE. High MPV and PDW in association with high LDL/HDL ratio in pregnant women herald risk of PE.

Platelet Indices and Its Association with Microvascular Complications Among Type 2 Diabetes Mellitus Patients in Northeast Ethiopia: A Cross-Sectional Study

PURPOSE

Platelet indices have been shown to be associated with complications of diabetes mellitus (DM). However, the clinical relevance of platelet indices for assessing the risk of being microvascular complications among patients with DM is largely overlooked. Hence this study aimed to determine the association of platelet indices with microvascular complications among type 2 DM patients.

PATIENTS AND METHODS

A hospital-based cross-sectional study was conducted among 352 type 2 DM patients from April 1 to May 30/2019 at Debre Berhan Referral Hospital. Data were collected by interview, physical measurements, document review, and laboratory tests. Then the data were entered into Epi-data manager-4.4.1.0 and exported into SPSS-25 for analysis. Platelet indices were compared between participants with and without microvascular complications using an independent t-test. A logistic regression model was used to assess the association between microvascular complications and platelet indices. All inferences were considered statistically significant at P<0.05.

RESULTS

One hundred seventeen (33.2%) of participants were suffering from at least one microvascular complications. The mean platelet volume (MPV), platelet distribution width (PDW), and platelet-large cell ratio (P-LCR) were significantly increased in DM patients with complications as compared to without complications (13.57±2.17fl vs. 11.76±1.93fl), (16.57±2.49fl vs. 14.97±2.41fl) and (28.09±7.58% vs. 24.19±6.46%), respectively (all are P˂0.001). In multivariate logistic regression analysis, MPV (AOR=1.68, 95% CI: 1.37-2.05), PDW (AOR=1.37, 95% CI: 1.15-1.63), P-LCR (AOR=1.07, 95% CI: 1.01-1.14), age (AOR=1.07, 95% CI: 1.01-1.12), and duration of DM (AOR=1.31, 95% CI: 1.18-1.46) were significantly associated with the presence of microvascular complications.

CONCLUSION

MPV, PDW, and P-LCR were significantly higher among type 2 DM patients with microvascular complications. This indicates that platelet indices can be used as prognostic markers of vascular complications and can be used as simple and cost-effective parameters to predict microvascular complications particularly in patients with old age and long duration of DM.

Mean Platelet Volume and Platelet Distribution Width Correlate with Microvascular Complications in Egyptian People with Type 2 Diabetes Mellitus

BACKGROUND

Type 2 diabetes is a part of metabolic syndrome associated with a higher risk of vascular complications. Diabetes is characterized by changes in platelet morphology, function, and platelet hyperactivity so, it's considered a prothrombotic condition. Morbidity and mortality in people with type 2 diabetes-related to micro and macrovascular complications. Novel biomarkers are needed to identify and treat people at higher risk.

OBJECTIVE

The main objective of this controlled cross-sectional study was to evaluate Platelet volume indices (PVI) in subjects with type 2 diabetes with and without complications in comparison to subjects without diabetes.

METHODS

Hundred and thirty-five subjects aged from 35 to 60 years were subdivided into 3 groups. Group A includes 55 subjects with type 2 diabetes with complications. Group B includes 45 subjects with type 2 diabetes without complications. Group C includes 35 normal healthy subjects. Detailed clinical history was taken. Also, PVI, fasting blood glucose (FBG), hemoglobin A1c, and creatinine were obtained.

RESULTS

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Plateletcrit (PCT), and Platelet large cell ratio (P-LCR) were significantly higher among subjects with retinopathy, nephropathy, and neuropathy than other subjects with diabetes who didn't develop complications (P<0.001). At cutoff value > 11.9 fL, MPV have diagnostic sensitivity 80% and specificity 97.8%. Whereas PDW >16.9fL has a sensitivity of 74.5% and specificity of 100% for diabetic microvascular complications (retinopathy, nephropathy, and neuropathy).

CONCLUSION

MPV and PDW may be considered as possible biomarkers for the early detection of diabetic microvascular complications.

Value of Platelet Distribution Width and Mean Platelet Volume in Disease Activity Score of Rheumatoid Arthritis

Background and Objective

Disease activity score 28 (DAS28) for rheumatoid arthritis (RA) is the commonly used DAS; it relies on clinical parameters that could be subjective. This work aimed to create a more accurate DAS for RA and assess its validity.

Patients and Methods

The study included 98 RA patients and 53 matched controls; they were interviewed, clinically examined, their visual analogue scales (VAS) were reported, and then blood samples were withdrawn for erythrocyte sedimentation rate (ESR), complete blood count (CBC), and C-reactive protein (CRP). Platelet indices (PIs) were obtained from the CBC including Plt (platelet count), mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT). DAS28 was calculated for each patient using RheumaHelper mobile software. Minitab Statistical Package^® and SPSS v20 software were used for data analysis.

Results and Conclusions

Results revealed perfect matching between patients and controls as regarding age and gender. ESR, CRP and PDW were significantly higher in patients than controls; also positive correlations were detected among these variables. A new DAS for RA was developed; ESR, CRP, PDW and MPV were the components for this index. Further analyses showed that this new score was significantly higher in patients than controls and correlated with DAS28 of the patients. Furthermore the new score could identify RA patients from healthy subjects (cut off value < -0.79) and stratified RA patients according to their disease activity into low, intermediate, high, or in remission. Conclusively, we developed a more precise, easily obtained new DAS for RA. This new DAS has both diagnostic/prognostic values in patients with RA.

Utility of platelet indices in alcoholic hepatitis: a retrospective study

Background:

The commonly available platelet indices are platelet distribution width (PDW), plateletcrit (PCT), and mean platelet volume (MPV). They have been used in diagnosis and prognosis of various abdominal disorders. They have never been used to predict severity of alcoholic hepatitis.

Methods:

A retrospective analysis of chronic alcohol consumers presenting with jaundice and deranged liver function tests was performed. Maddrey discriminant function (MDF) and modified end-stage liver disease (MELD) scores were calculated and patients compared between severe and nonsevere alcoholic hepatitis (MDF ≥32 vs MDF <32 and MELD >20 vs MELD ≤20). Logistic regression analysis was performed to find significant predictors. Receiver operating characteristic was used to find the area under the curve. Spearman correlation was performed to discover association between platelet indices and severity scores.

Results:

There were 119 patients in the study. Coexisting illnesses included pancreatitis, cirrhosis, infections, and alcohol withdrawal syndrome. The mean age (years), duration of alcohol consumption (years), and ethanol (g/day) were 45.13 ± 11.53, 18.84 ± 11.40, and 65.61 ± 45.42, respectively. The average MELD and Maddrey scores were 14.13 ± 5.17 and 36.45 ± 29.63, respectively. The mean platelet counts, PDW, MPV, and PCT were 194.01 ± 178.82 × 10⁹/L, 17.10 ± 1.21, 5.99 ± 0.96, and 0.14 ± 0.04, respectively. PDW >18 and MPV had a significant positive correlation with MELD scores. Only bilirubin and prothrombin prolongation were significant predictors of severe alcoholic hepatitis. The area under the curve was highest for PCT at 0.622 (P = .07; confidence interval = 0.500–0.743).

Conclusions:

Platelet indices appear to be significantly altered in alcoholic hepatitis, but they do not predict severe disease. Whether this inability to predict severe alcoholic hepatitis is due to coexisting illnesses such as pancreatitis, cirrhosis, and infection needs to be studied further.

Can prepartum platelet indices be a parameter to predict postpartum hemorrhage?

OBJECTIVE

Postpartum hemorrhage (PPH) is the single largest contributor to maternal mortality worldwide. It has been demonstrated that certain platelet parameters are indicative of platelet reactivity. The aim of this study was to determine whether antenatal platelet indices can be used as risk factors in the prediction of primary PPH.

METHODS

This comparative case-control study involved 3207 pregnant women at term who were recruited over one year period in İstanbul. Postpartum hemorrhage, defined as blood loss ≥1000 mL within 24 h after delivery. The study group consisted of 42 patients who developed primary PPH after vaginal delivery without defined risk factors. The patients in the control group were matched with age, parity, body mass index (BMI), and hemoglobin value. Platelet indices - platelet count, mean platelet volume (MPV), platelet distribution width, and plateletcrit were measured prior to delivery and evaluated for the prediction of PPH.

RESULTS

Prepartum MPV and PDW values were determined to be lower in the patients with in the PPH group, when compared to the healthy group (respectively, p < .001 and p < .004). By receiver-operating characteristic analysis, MPV and PDW were able to distinguish between patients with and without any bleeding (respectively, AUC 0.823, 95% confidence interval (CI) 0.735-0.912, (AUC) 0.682, 95% CI 0.569-0.795). Prepartum MPV (cutoff = 10.95 fL) had a high AUC (>0.8) for predicting PPH, with a specificity of 81% and sensitivity of 69%.

CONCLUSION

Results suggest a novel hypothesis that pre-delivery lower MPV value may be used predicting PPH.

Preoperative platelet morphology parameters as prognostic predictors for endometrial malignant carcinoma stage and progesterone receptor

To investigate preoperative platelet morphology parameters and other whole blood cells in patients of malignant endometrial carcinoma compared with benign disease.Retrospective analysis was performed through collecting patients' hematological parameters before performing total abdominal/vaginal hysterectomy and standard radical surgery due to benign and malignant endometrial disease between 2006 and 2017. Parameters required included white blood cell (WBC), hemoglobin, platelet count (PLT), platelet distribution width (PDW), mean platelet volume (MPV), and platelet thrombocytocrit (PCT). And neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated. For malignant carcinoma, Ki-67 percentage and progesterone receptor (PR) status were further collected.A total of 288 patients were included with 145 benign cases and 143 malignant cases. Patients of confirmed endometrial carcinoma showed a significant lower value of PDW (55.21 ± 4.72 vs 49.54 ± 5.89, P < .001), meanwhile significant higher values of MPV (7.12 ± 1.56 vs 8.89 ± 1.67, P < .001) and PCT (24.18 ± 6.89 vs 27.93 ± 8.93, P = .003). Further analysis of endometrial carcinoma patients showed that no significant difference in platelet parameters was found between patients with stage I to II and stage III to IV (P > .05), while increased value in PDW and reduced value in MPV was found in PR negative compared with positive patients.Preoperative platelet morphology parameters seemed to be used as one kind of predictive factors to discriminate malignant and benign endometrial disease. Limited by present study design, further prospective studies are required to support this finding.

Significance of platelet indices as severity marker in nonthrombocytopenic preeclampsia cases

CONTEXT

Preeclampsia is often asymptomatic, and hence, its detection depends on signs or investigations. The platelet (PLT) parameters, in cases of preeclampsia with normal PLT count, are seldom analyzed. Hence, this study was undertaken to study the PLT parameters in nonthrombocytopenic preeclampsia cases.

AIM

The aim was to evaluate the use of PLT indices as severity markers in nonthrombocytopenic preeclampsia cases.

SUBJECTS AND METHODS

This prospective study was done on 120 cases of severe preeclampsia, 115 cases of preeclampsia without severe features, and 203 normal pregnant women admitted in the obstetrics wards during the study period of 1 year. The PLT indices obtained by analyzing anticoagulated blood were recorded.

STATISTICAL ANALYSIS USED

Analysis of variance test was used to see the significance of association. Receiver operating characteristic (ROC) curve and binary regression analysis was used to estimate the cutoff value and examine the predictive value of the PLT parameters in the disease progression of preeclampsia.

RESULTS

Even in the absence of thrombocytopenia, mean platelet volume (MPV) and PLT distribution width were significantly higher in severe preeclampsia group (P < 0.001) and were also positively correlating with mean arterial pressure (r = 0.38 and 0.20, respectively). ROC curve analysis showed that MPV had the highest area under the curve of 0.78 (95% confidence interval [0.719-0.842]). Cutoff value of >10.95 fl for MPV was found to have significant predictive value for disease progression in preeclampsia.

CONCLUSIONS

Even in the absence of thrombocytopenia, PLT indices, especially MPV, have a good diagnostic significance in detecting severe preeclampsia. Further studies are required to evaluate their role as biomarkers in preeclampsia.

Modulation of Hematological Indices of Normal and Alloxan-Induced Diabetic Rabbits by Aqueous Extract of Pleurotus tuberregium Sclerotia

OBJECTIVE

The ability of an aqueous extract of the sclerotia of Pleurotus tuberregium to modulate hematological parameters was investigated in normal and alloxan treated rabbits.

METHODS

The extract was subjected to atomic absorption spectrophotometric and flame ionization detector-coupled-gas chromatographic (GC-FID) analysis. Diabetes mellitus was induced by a 120 mg/kg body weight intravenous injection of alloxan. Metformin was orally administered at 50 mg/kg, while the extract was administered (both to normal and diabetic rabbits) at 100, 200 and 300 mg/kg.

RESULTS

Analysis of the extract showed that it had high contents of calcium, magnesium, manganese and potassium. Eleven known glycosides were detected, comprising mainly of amygdalin (37.7%), digoxin (14.4%), dhurrin (14.0%), linamarin (13.6%), prunasin (10.8%) and digitoxin (8.4%). Also detected were twelve known saponins, consisting mainly of sapogenin (40.3%) and neochlorogenin (21.8%); and twelve known lignans, consisting mainly of matairesinol (59.7%), secoisolariciresinol (20.9%) and lariciresinol (14.9%). Compared to the Diabetic control, the hematocrit, hemoglobin concentration, mean cell hemoglobin, mean cell hemoglobin concentration, mean corpuscular volume, red cell distribution width; and red cell, total white cell, lymphocytes, granulocytes and platelet counts of the treated groups were significantly (p<0.05) higher.

CONCLUSION

The above result showed that the extract had a positive effect on the hemopoietic system of the treated animals, at least at the doses at which it was administered in this study.

Association between infection with Helicobacter pylori and platelet indices among school-aged children in central Ethiopia: a cross-sectional study

OBJECTIVE

Previous clinical studies in adults from developed countries have implicated Helicobacter pylori infections in the development of thrombocytopenia. However, studies in children, particularly those from low-income countries, are unusually scarce. We examined the association between H. pylori infection and platelet indices in young Ethiopian school children.

DESIGN

Cross-sectional study SETTING: This study was conducted in five elementary schools located in central Ethiopia.

PARTICIPANTS

Blood and stool samples were collected from 971 children across five elementary schools in Ethiopia. H. pylori infection was diagnosed using stool antigen and serum antibody tests, and haematological parameters were measured using an automated haematological analyser. An interviewer-led questionnaire administered to mothers provided information on demographic and lifestyle variables. The independent effects of H. pylori infection on platelet indices were determined using multivariate linear and logistic regressions.

STUDY OUTCOMES

H. pylori-infected children had a lower average platelet count and mean platelet volume than uninfected after adjusting the potential confounders (adjusted mean difference: -20.80×10⁹/L; 95% CI -33.51 to -8.09×10⁹, p=0.001 and adjusted mean difference: -0.236 fL; 95% CI -0.408 to -0.065, p=0.007, respectively). Additionally, H. pylori-infected children had lower red blood cell counts (adjusted mean difference: -0.118×10¹²/L; 95% CI -0.200 to -0.036, p=0.005) compared with non-infected.

CONCLUSION

Our study from a developing country provides further support for an association between H. pylori infections and reduced platelet indices in young Ethiopian school children, after controlling for potential confounders. Further research is needed, particularly longitudinal studies, to establish causality.

Platelet Indices as a Predictor of Microvascular Complications in Type 2 Diabetes

BACKGROUND

Type 2 diabetes mellitus (T2DM) patients have a higher risk of developing micro- and macrovascular complications, which lead to decrease in the quality of life and increase in morbidity. Platelet indices have been available in the laboratory routine using blood cell counters for several years. These indices could alert us regarding endothelial dysfunction and in turn regarding the microvascular complications. Hence, this study was done to prove the correlation between platelet indices and microvascular complications in T2DM.

MATERIALS AND METHODS

In total, 125 diabetic patients attending diabetes OPD and admitted in medicine department along with age and sex-matched non-diabetic controls were studied. A detailed history was taken regarding duration of diabetes, medication, past history of stroke, IHD, and hypertension. Patients with T2DM were specially evaluated for microvascular complications. Platelet indices, fasting blood glucose, Post prandial blood glucose, HbA1C, and Sr. Creatinine were obtained from venous blood samples. All parameters were then subjected to statistical analysis using SPSS 17.0.

RESULTS

Platelet indices, namely MPV, PCT, PDW, and P/LCR were significantly higher in diabetic individuals than those in age and gender-matched controls. Moreover, the increase in MPV, PDW, and P/LCR was more significant in diabetic subjects with microvascular complications when compared with those without microvascular complications. Platelet dysfunction also showed a positive association with HbA1C, retinopathy, nephropathy, and neuropathy individually.

CONCLUSIONS

Changes in platelet indices were found to be statistically associated with diabetes and its complications.

Prognostic value of mean platelet volume to plateletcrit ratio in patients with osteosarcoma

Objective

The objective of this study was to investigate the prognostic value of preoperative mean platelet volume to plateletcrit (MPV/PCT) ratio in patients with osteosarcoma.

Materials and methods

The retrospective study included 188 consecutive osteosarcoma patients who experienced neoadjuvant chemotherapy and surgical resection of tumor. The relationships between MPV/PCT and clinicopathological characteristics were analyzed. The Kaplan-Meier analysis and Cox regression proportional hazard model were applied to assess the prognostic value of MPV/PCT ratio.

Results

MPV/PCT ratio was found to be significantly associated with platelet count, platelet distribution width, and PCT (all P<0.001). Kaplan-Meier analysis showed that high MPV/PCT ratio (≥43.58) was associated with a prolonged disease-free survival (DFS, P=0.035). The multivariate Cox revealed that only good chemotherapy response was an independent predictor of better DFS in the overall population. However, the stratification analysis showed that a high MPV/PCT ratio (≥43.58) was indicated as an independent prognostic factor for a favorable DFS (HR =0.137, 95%CI =0.029-0.644, P=0.012) in the male osteosarcoma patients but not in female patients.

Conclusion

The high preoperative MPV/PCT ratio may serve as an independent prognostic factor for a favorable prognosis in male osteosarcoma patients. Further studies are needed to confirm the findings.

STREPTOZOTOCIN-INDUCED DIABETES MELLITUS - A PARADOX OF HIGH INTRINSIC PLATELET REACTIVITY AND LOW IN VITRO PLATELET AGGREGATION

CONTEXT

Studies of platelet function in diabetics are inconsistent, some studies reporting higher platelet reactivity, while others showed no change.

OBJECTIVE

We aimed to evaluate platelet indices and in vitro platelet aggregation in rats with long-lasting (28 weeks) diabetes mellitus.

DESIGN

Twelve controls and 14 diabetic rats were investigated. Diabetes was induced in 11-week-old rats using streptozotocin (60 mg/kg,i.p.). Platelet indices and in vitro adenosine diphosphate (ADP)-, protease-activated receptor 4 (PAR4) agonist-, and arachidonic acid (AA)-induced platelet aggregation were assessed at the age of 38 weeks.

RESULTS

Compared to controls, diabetic rats presented lower platelet count and plateletcrit (both p≤0.001), and higher mean platelet volume (p<0.01). ADP- (p=0.04) and AA-induced (p<0.01) platelet aggregation were lower in diabetic compared with control rats, whereas PAR4 agonist-induced platelet aggregation was similar between the two groups (p=1.00).

CONCLUSIONS

This study demonstrates a paradox of high intrinsic platelet reactivity and low in vitro ADP- and AA-induced platelet aggregation in diabetic rats compared with non-diabetic controls. The relevance of in vitro platelet aggregation to the contribution of platelets to in vivo thromboembolic events in diabetic rats remains questionable.

The relationship between platelet indices and ABO blood groups in healthy adults

BACKGROUND

ABO blood groups have been suggested to have a high correlation with cardiovascular diseases (CVDs). It has also been postulated that platelet indices, including mean platelet volume (MPV) and platelet distribution width (PDW), are very important in the development and progression of CVDs. However, despite these common associations with CVDs, as far as we know, there are no studies investigating platelet indices in ABO blood groups. Thus, the aim of this study was to investigate whether platelet indices are associated with ABO blood groups.

METHODS

The study included 301 healthy volunteers (99 women and 202 men; mean age: 32.59 ± 7.52 years) whose blood groups were determined by the gel column method using agglutination techniques. Platelet indices were studied by an automated blood counter.

RESULTS

No considerable differences in age, gender, or Rh factors were observed among ABO blood groups. MPV was detected to be considerably lower in O and A blood group subjects than in AB and B blood group subjects. Similarly, PDW was significantly lower in O and A blood group subjects than in B blood group subjects. Additionally, MPV in the O blood group subjects was significantly lower than in the non-O blood group subjects.

CONCLUSIONS

Because MPV and PDW are used as markers of CVDs, individuals with O and A blood groups in this study may be considered to have a lower risk of CVDs than AB and B blood group subjects. However, prospective cohort studies involving a greater number of volunteers are needed to elucidate these relationships.

The association between placenta previa and leukocyte and platelet indices - a case control study

OBJECTIVES

Despite medical advances, rising awareness, and satisfactory care facilities, placenta previa (PP) remains a challenging clinical entity due to the risk of excessive obstetric hemorrhage. Etiological concerns gave way to life-saving concerns about the prediction of maternal outcomes due to hemorrhage. Our study aimed to detect an early predictive marker of placenta previa.

MATERIAL AND METHODS

Ninety-three pregnant patients diagnosed with PP and 247 controls were recruited for this retro-spective study. Platelet and leukocyte indices were compared between the two groups.

RESULTS

The groups were similar with regard to age distribution (31.2 ± 5.1 years [mean ± SD] in the PP group and 31.7 ± 4.2 years in controls), body mass index (BMI) (27.7 ± 3.6 kg/m2 in the PP group and 27.4 ± 4.6 kg/m2 in controls), and most characteristics of the obstetric history. Total leukocyte count, neutrophil count, and neutrophil-to-lymphocyte ratio were significantly higher in the PP group. Mean platelet volume (MPV) and large platelet cell ratio (P-LCR) values were significantly lower in the PP group as compared to controls, with regard to third trimester values. However, patients who were diagnosed postnatally with placenta percreta had lower MPV and P-LCR values than other patients with PP. There were no statistically significant differences between the two groups as far as first trimester values were concerned.

CONCLUSIONS

Platelet and leukocyte indices in the third trimester of pregnancy may be valuable predictors of placenta previa and placenta percreta. More comprehensive studies are needed to address this issue.

Relationship Between Plasma Pentraxin 3 Concentration and Platelet Indices in Patients With Stable Coronary Artery Disease

Few reports have analyzed the effect of pentraxin 3 (PTX3) on platelets and their activation. We explored the association between plasma PTX3 and platelet indices. Forty-nine patients with stable coronary artery disease (CAD) were enrolled. Based on median PTX3, the study population was divided into group 1 (n = 25; PTX3 ≤ 0.98 ng/mL) and group 2 (n = 24; PTX3 > 0.98 ng/mL). Platelet indices investigated included mean platelet volume (MPV), platelet distribution width (PDW), platelets and large cell ratio (P-LCR), MPV to platelet count ratio (MPV/PC), platelet to lymphocyte ratio (PLR), and MPV to lymphocyte ratio (MPVLR). Patients with lower PTX3 had a higher lymphocyte count. Platelet count was similar in both groups. Notwithstanding, patients with higher PTX3 concentrations had elevated MPV (8.3 vs 10.0 fL; P < .001) and PDW (9.4 vs 12.4 fL; P < .001). However, the MPV/PC ratio was similar in both groups. Thromboinflammatory biomarkers (PLR, MPVLR) were also elevated in group 2. Pentraxin 3showed a strong, positive correlation with MPV ( r = .75, P < .01) and PDW ( r = .80, P < .01), and weak to moderate correlation with MPVLR. In conclusion, PTX3 is associated with larger platelet size as assessed by platelet volume indices. There is a strong correlation between plasma PTX3 level and MPV and PDW.

Changes in Platelet Count and Size Indices in Adolescent Patients With Anorexia Nervosa

The significance of platelet size indices has not been widely analyzed in anorexia nervosa (AN). It seems important to get more knowledge on the easily available indices of platelet function obtained by routine complete blood count analysis in patients with AN. We analyzed platelet count (PLT), platelet distribution width (PDW), and mean platelet volume using an automated blood cell counter in 25 females with AN and healthy age- and gender-matched nonatopic controls. Mean PLT was significantly lower in patients with AN than in the control group. Platelet distribution width values in patients with AN were significantly higher than those in the controls. Platelet distribution width values significantly correlated with the disease duration and rate of body weight loss in the anorectic patients. Anorexia nervosa in adolescents is associated with a decrease in PLT along with an increased PDW, which may be an indicator of dysregulated thrombopoiesis.

Is there clinical value in counting nucleated red blood cells and platelet indices in primary immunodeficiency disease?

Ekici-Günay N, Çakır I, Çelik T. Is there clinical value in counting nucleated red blood cells and platelet indices in primary immunodeficiency disease? Turk J Pediatr 2017; 59: 657-663. Infections are the most common presentation of primary immunodeficiency diseases (PIDs). The increase of nucleated red blood cell (NRBC) count is interpreted as a systemic inflammatory response. Platelets play an important role in the pathogenesis of inflammatory disease. The relationship of platelet indices (PIs) and disease activity have been demonstrated in various inflammatory diseases. The aims of this study was to evaluate and compare NRBC and platelet/lymphocyte ratio (PLR), PIs [mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (PLCR)] with a possible indirect inflammatory marker in children with PIDs. Data were recorded retrospectively from 66 PIDs patients, < 16 years of age. The relationships between peripheral NRBC, C-reactive protein (CRP) and PIs were analyzed. NRBC was positively correlated with CRP (p < 0.037), white blood cells (WBC) (p < 0.020), PLR (p < 0.044), PDW (p < 0.037) and PLCR (p < 0.001) and it was negatively correlated with platelet distribution width (PDW) (p < 0.036) in PIDs patients. A cutoff level of 0.80% NRBC, ≥15.55% PDW, ≥8.65 MPV and ≥43.67 PLR showed the best performance to predict PIDs, with 81% sensitivity, 27% specificity; 61% sensitivity, 37% specificity; 70% sensitivity, 43% specificity; 54% sensitivity, 40% specificity, respectively. Our results suggested that these indices may be used as auxillary diagnostic markers of PIDs with positive NRBC, showing more meaningful results than those known as the traditional infection markers for PIDs prediction. Elevated NRBC and MPV and low PDW are associated with infections and could be helpfull in the early diagnostic susception of PIDs. They can be used as rapidly accessible parameters for awareness of PIDs. These markers are easy to use in daily practice and without extra costs.

Elevated thrombopoietin and platelet indices confirm active thrombopoiesis but fail to predict clinical severity of puumala hantavirus infection

We evaluated the mechanisms of thrombocytopenia and procoagulant changes in relation with clinical variables in a cohort of patients with acute hantavirus disease.Blood samples of 33 prospectively recruited, consecutive, hospitalized patients with acute Puumala virus-induced hemorrhagic fever with renal syndrome (HFRS) were collected acutely and at the recovery visit (control). Serum thrombopoietin (TPO) and activity of plasma microparticles (MPs) from various cell sources were measured with enzyme-linked immunosorbent assay-based methods. The results were related to data on platelet indices and functions, coagulation variables, and clinical disease.Serum TPO was nearly 4-fold higher acutely compared with the control (median 207 pg/mL, range 56-1258 pg/mL vs. median 58 pg/mL, range 11-241 pg/mL, P < 0.001) and coincided with high mean platelet volume (MPV) and immature platelet fraction (IPF%). Prothrombin fragments and D-dimer were high acutely compared with the control (F1 + 2 median 704 pmol/L, range 284-1875 pmol/L vs. median 249 pmol/L, range 118-556 pmol/L, P < 0.001; D-dimer median 2.8 mg/L, range 0.6-34.0 mg/L vs. median 0.4 mg/L, range 0.2-1.1 mg/L, P < 0.001), and associated with low platelet count and severe acute kidney injury (AKI). MPs' procoagulant activity was high acutely only among patients with mild AKI (plasma creatinine below the median at the time of the measurement).Upregulated TPO together with high MPV and IPF% confirm active thrombopoiesis, but do not predict severity of HFRS. Simultaneously, elevated prothrombin fragments and D-dimer suggest increased consumption of platelets in patients with severe AKI. Activity of platelet-derived MPs in HFRS should be studied with flow cytometry in a larger cohort of patients.

Platelet index levels and cardiovascular mortality in incident peritoneal dialysis patients: a cohort study

Prior studies have shown that the levels of some platelet (PLT) indices were associated with mortality in patients undergoing hemodialysis. We aimed to investigate whether the changes in PLT indices associated with mortality in patients on peritoneal dialysis (PD). A single-center, retrospective observational cohort study was conducted in incident PD patients from 1 January 2006 to 31 December 2012, and followed up until 31 December 2014. Cox proportional hazard models were used to examine the relationships between the levels of PLT indices including PLT, plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (PLCR), and mortality. Of 1324 patients, 276 (20.8%) died during follow-up (median, 37; IQR, 3-107.4 months), among which 134 were due to cardiovascular diseases (CVD). The highest tertile of PLT levels at baseline was associated with increased risk for cardiovascular mortality after adjustment for demographic, clinical characteristics, and laboratory variables (hazard ratio [HR]:1.93; 95% confidence interval [CI]: 1.16-3.20). The similar treads were also observed in the middle and the highest tertile of the PCT level (HR: 1.68, 95%CI: 1.00-2.81 and HR: 1.89, 95%CI: 1.14-3.14, respectively). In addition, the highest tertile of PCT was associated with increased all-cause mortality (HR: 1.41, 95%CI: 1.01-1.96). However, none of the associations in MPV, PDW, and PLCR analyses reached statistical significance (HR: 0.71, 95%CI: 0.43-1.16; HR: 0.72, 95%CI: 0.45-1.18 and HR: 0.74, 95%CI: 0.46-1.19, respectively). These results suggest that higher PLT and PCT may be associated with higher risk for cardiovascular mortality in incident PD patients. Additional studies are needed to investigate whether correction of these two PLT indices reduces the risk.

An association of platelet indices with blood pressure in Beijing adults: Applying quadratic inference function for a longitudinal study

The quadratic inference function (QIF) method becomes more acceptable for correlated data because of its advantages over generalized estimating equations (GEE). This study aimed to evaluate the relationship between platelet indices and blood pressure using QIF method, which has not been studied extensively in real data settings.A population-based longitudinal study was conducted in Beijing from 2007 to 2012, and the median of follow-up was 6 years. A total of 6515 cases, who were aged between 20 and 65 years at baseline and underwent routine physical examinations every year from 3 Beijing hospitals were enrolled to explore the association between platelet indices and blood pressure by QIF method. The original continuous platelet indices were categorized into 4 levels (Q1-Q4) using the 3 quartiles of P25, P50, and P75 as a critical value. GEE was performed to make a comparison with QIF.After adjusting for age, usage of drugs, and other confounding factors, mean platelet volume was negatively associated with diastolic blood pressure (DBP) (Equation is included in full-text article.)in males and positively linked with systolic blood pressure (SBP) (Equation is included in full-text article.). Platelet distribution width was negatively associated with SBP (Equation is included in full-text article.). Blood platelet count was associated with DBP (Equation is included in full-text article.)in males.Adults in Beijing with prolonged exposure to extreme value of platelet indices have elevated risk for future hypertension and evidence suggesting using some platelet indices for early diagnosis of high blood pressure was provided.

The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review

Platelet indices (PI) -- plateletcrit, mean platelet volume (MPV) and platelet distribution width (PDW) -- are a group of derived platelet parameters obtained as a part of the automatic complete blood count. Emerging evidence suggests that PIs may have diagnostic and prognostic value in certain diseases. This study aimed to summarize the current scientific knowledge on the potential role of PIs as a diagnostic and prognostic marker in patients having emergency, non-traumatic abdominal surgery. In December 2015, we searched Medline/PubMed, Scopus and Google Scholar to identify all articles on PIs. Overall, considerable evidence suggests that PIs are altered with acute appendicitis. Although the role of PI in the differential diagnosis of acute abdomen remains uncertain, low MPV might be useful in acute appendicitis and acute mesenteric ischemia, with high MPV predicting poor prognosis in acute mesenteric ischemia. The current lack of consistency and technical standards in studies involving PIs should be regarded as a serious limitation to comparing these studies. Further large, multicentre prospective studies concurrently collecting data from different ethnicities and genders are needed before they can be used in routine clinical practice.

Mean Platelet Volume (MPV), Platelet Distribution Width (PDW), Platelet Count and Plateletcrit (PCT) as predictors of in-hospital paediatric mortality: a case-control Study

BACKGROUND

Thrombocytopenia has been shown to predict mortality. We hypothesize that platelet indices may be more useful prognostic indicators. Our study subjects were children one month to 14 years old admitted to our hospital.

AIM

To determine whether platelet count, plateletcrit (PCT), mean platelet volume (MPV) and platelet distribution width (PDW) and their ratios can predict mortality in hospitalised children.

METHODS

Children who died during hospital stay were the cases. Controls were age matched children admitted contemporaneously. The first blood sample after admission was used for analysis. Receiver operating characteristic (ROC) curve was used to identify the best threshold for measured variables and the ratios studied. Multiple regression analysis was done to identify independent predictors of mortality.

RESULTS

Forty cases and forty controls were studied. Platelet count, PCT and the ratios of MPV/Platelet count, MPV/PCT, PDW/Platelet count, PDW/PCT and MPV × PDW/Platelet count × PCT were significantly different among children who survived compared to those who died. On multiple regression analysis the ratio of MPV/PCT, PDW/Platelet count and MPV/Platelet count were risk factors for mortality with an odds ratio of 4.31(95% CI, 1.69-10.99), 3.86 (95% CI, 1.53-9.75), 3.45 (95% CI, 1.38-8.64) respectively. In 67% of the patients who died MPV/PCT ratio was above 41.8 and PDW/Platelet count was above 3.86. In 65% of patients who died MPV/Platelet count was above 3.45.

CONCLUSION

The MPV/PCT, PDW/Platelet count and MPV/Platelet count, in the first sample after admission in this case control study were predictors of mortality and could predict 65% to 67% of deaths accurately.

Relationship of platelet indices with acute stent thrombosis in patients with acute coronary syndrome

INTRODUCTION

Despite major advances in stent technology and antithrombotic therapy, the development of stent thrombosis continues to be a major problem in patients who have undergone percutaneous coronary intervention (PCI). Although a few studies have investigated the relationship between early stent thrombosis and platelet activity, the relationship between acute stent thrombosis (AST) (within the first 24 h) and platelet indices is unclear.

AIM

We investigated the relationship between AST development and platelet indices in acute coronary syndrome patients.

MATERIAL AND METHODS

In our case-control study, 33 patients who underwent PCI with subsequent AST development and 59 patients without AST were selected by propensity analysis. We compared the clinical, angiographic, and laboratory data between the AST and control groups.

RESULTS

Mean platelet volume (MPV) (p=0.002) and platelet distribution width (p=0.014) were significantly higher and platelet count (p=0.017) was significantly lower in the AST group. Logistic regression analyses showed that MPV was a significant independent predictor of AST (OR = 1.67; 95% CI: 1.11-2.51; p=0.013). In the ROC analyses, the cut-off value of MPV to detect AST was > 9.1 fl with a sensitivity of 90.9%, a specificity of 42.4%, a positive predictive value of 46.9% and a negative predictive value of 89.3% (AUC: 0.687, 95% CI: 0.582-0.780, p=0.001).

CONCLUSIONS

Our study shows that baseline MPV predicts the development of AST in patients with ACS. Mean platelet volume therefore might be an easily accessible marker in the identification of patients at high risk for the development of AST.

Value of serial platelet indices measurements for the prediction of pulmonary embolism in patients with deep venous thrombosis

Background

To date, no validated biomarkers with high sensitivity and specificity have been established for diagnosis of pulmonary embolism (PE) in patients with deep venous thrombosis (DVT). There is a need to develop simple and reliable noninvasive tests that can accurately identify patients with PE, even in small hospitals or clinics. The aim of this study was to investigate the value of mean platelet volume (MPV) and platelet distribution width (PDW) for predicting occurrence of PE in patients with DVT.

Methods

Records of acute DVT patients were reviewed retrospectively. Group 1 consisted of 50 patients with acute DVT and group 2 consisted of 50 patients with acute DVT who developed PE during follow-up. The control group consisted of patients with uncomplicated primary varicose veins of the lower limbs. Venous peripheral blood samples for measurement of MPV, PDW, and platelet count were drawn on admission, before the treatment, and at the time of PE diagnosis.

Results

MPV and PDW levels at the time of PE diagnosis were higher in group 2 than group 1 (P<0.001 and P=0.026, respectively). Receiver operating characteristics analysis revealed that a 5.2% increase in admission PDW during follow-up provided 70% sensitivity and 82% specificity (area under the curve, 0.80), and a 6.6% increase in admission MPV during follow-up provided 74% sensitivity and 83% specificity (area under the curve, 0.84) for prediction of PE occurrence in patients with DVT. PDW and MPV levels at the time of PE diagnosis were found to be independent risk factors for the occurrence of PE in patients with DVT.

Conclusion

Serial measurements of MPV and PDW, and percent change in MPV and PDW appears to be a useful marker for predicting occurrence of acute PE in patients with a first episode of acute proximal DVT.

Relation of platelet indices to severity of coronary artery disease in patients undergoing primary percutaneous coronary intervention

AIM

We investigated the association between platelet indices and the severity of coronary artery disease (CAD) in patients with ST-segment-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI).

METHODS

A total of 484 consecutive patients who were routinely referred to coronary angiography for STEMI and 81 age- and gender-matched patients with normal coronary arteries were included in the present study. We analyzed the relation between the platelet distribution width (PDW) and the angiographic severity of CAD. The SYNTAX score was used for assessing the severity of coronary atherosclerosis.

RESULTS

The mean platelet volume (MPV), the plateletcrit (PCT) and the neutrophil levels were significantly higher in the STEMI group than in the control group. Patients with an elevated SYNTAX score (>32) had higher PDW values. The levels of plateletcrit and the estimated glomerular filtration rate (eGFR) were lower in the high SYNTAX score group compared to the moderate-to-low SYNTAX score group. The PDW was positively correlated with age (r = 0.128, p=0.004) and SYNTAX score (r = 0.209, p<0.001). There was a mild, significant inverse association between the PDW level and the eGFR (r = -0.101, p=0.049), the mean platelet volume (MPV) (r = -290, p<0.001) and the PCT (r = -345, p<001). Using multivariate logistic regression analysis, we found that age (OR = 1.046, 95% CI 1.013-1.079, p=0.005), diabetes (OR = 4.779, 95% CI 2.339-9.767, p<0.001) and PDW (OR = 1.229, 95% CI 1.072-1409, p=0.003) were independent correlates of high SYNTAX score.

CONCLUSION

Platelet distribution width, an inexpensive and easily measurable laboratory variable, is independently associated with high SYNTAX score.

The evaluation of platelet indices and markers of inflammation, coagulation and disease progression in treatment-naïve, asymptomatic HIV-infected individuals

INTRODUCTION

Cardiovascular disease and thrombotic events have emerged as major causes of mortality in people living with HIV. Activated platelets play a key role in both inflammation and thrombosis. Haematology analysers measure a variety of platelet indices, which could be surrogate markers of platelet activation. Flow cytometry offers the discrimination of platelet subpopulations and evaluation of the activation status of platelets. This study aimed to measure platelet indices in untreated HIV infection and to evaluate their relationship with markers of immune activation and disease progression.

MATERIALS AND METHODS

One hundred and eighty-five antiretroviral therapy (ART)-naïve HIV-infected and 145 HIV-negative healthy individuals were recruited. Platelet indices measured using the ADVIA 2120 platform consisted of platelet count (PLT ×10(9) /L), mean platelet volume (MPV fL), platelet distribution width (PDW%) and plateletcrit (PCT%). These were correlated with CD4 count, %CD38 on CD8+ (CD38/8) T cells, viral load, fibrinogen, D-dimers and CD31+ platelet CD62P and CD36 expression, determined using flow cytometry.

RESULTS

The HIV group had decreased MPV levels [median 7.7 (7.1-8.3) vs. control group 8.4 (7.8-9.2), P < 0.0001], which correlated with PCT% (r = 0.3038, P = 0.0013), viral load (r = 0.2680, P = 0.0177) and PDW% (r = 0.2479, P = 0.0257). Additionally, the MPV correlated with CD4 count r = -0.2898, P = 0.0075. The HIV group had decreased PDW%, 49.35 (46.40-52.65) vs. control group, 53.90 (50-56.80), P = 0.0170. In addition, the PDW% showed correlations with D-dimers (r = 0.443, P = 0.03) and %CD36 (r = -0.3666, P = 0.0463).

CONCLUSION

Platelet indices may offer a rapid and affordable method for monitoring platelet activation and disease progression in patients with HIV.