BACKGROUND:Bone marrow examination is the gold standard test in determining the cause of thrombocytopenia; whether it is of hypoproductive or hyperdestructive nature. However, this process has distinct disadvantages such as being invasive, not feasible in critical situations and is often not preferred by clinicians and patients alike. The introduction of platelet indices in automated hematology analyzers has provided a small window into the cause of thrombocytopenias in the recent years. Mean platelet volume (MPV) has evoked much interest in this regard. This study aimed at assessing the predictive value of MPV in determining the aetiology of thrombocytopenia. MATERIALS AND METHODS:We analyzed 100 cases of thrombocytopenia (platelet count < 100x10 3 / cu.mm) on a retrospective basis for a period of one month. The cases were divided into 2 groups: with and without bone marrow diseases; based on individual pathophysiology. A statistical analysis was done to assess predictive values, odds ratio and confidence intervals and also to elicit a cut-off value for MPV. RESULTS: The mean MPV in the group with marrow disease was 8.95fl while the group without marrow disease was 9.42fl. The difference in MPV between the 2 groups was not statistically significant (P value: 0.088). The sensitivity and specificity scores as tabulated by the receptor operating characteristic (ROC) curve at a cut-off of 9.35fl were 69% and 55% respectively. CONCLUSIONS: The study concluded that although MPV may provide a small initial insight into the aetiology of thrombocytopenia, it is limited by insufficient sensitivity and specificity. A bone marrow examination continues to be the gold standard to differentiate the hypoproductive and hyperdestructive thrombocytopenias.

In patients with cyanotic congenital heart disease (CCHD), the need for prior antibiotic prophylaxis for infective endocarditis is well known to dentists, but not many dentists are aware of the associated haemorrhagic tendencies in such patients. Haemostatic abnormalities associated with CCHD are an important aspect that is often overlooked by both physicians and dentists. We briefly review the literature to highlight the importance of more elaborate haematological evaluation in patients with CCHD, prior to any oral surgical procedures.

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