A prospective evaluation of normal mean platelet volume in discriminating hyperdestructive thrombocytopenia from hypoproductive thrombocytopenia

Abstract

Bone marrow (BM) examination is the gold standard test in discriminating between hyperdestructive thrombocytopenia and hypoproductive thrombocytopenia. However, this procedure is invasive. Mean platelet volume (MPV) is simple and may be used as an alternative diagnostic test in distinguishing these two types of thrombocytopenia. All thrombocytopenic patients (platelet count: <150.0 x 10(9)/l), except those with congestive splenomegaly, thrombotic thrombocytopenic purpura, and disseminated intravascular coagulopathy, were enrolled into the study prospectively. The mean MPV of normal Thais (7.9 fl) was tested as a cutoff value. Any thrombocytopenic patient with MPV of >7.9 fl would be presumptively diagnosed as hyperdestructive thrombocytopenia, whereas one with MPV of <or= 7.9 fl would be presumptively diagnosed as hypoproductive thrombocytopenia. One hundred two patients were completely evaluated. When compared with the BM examination, the MPV of >7.9 fl could predict hyperdestructive thrombocytopenia with a sensitivity of 82.3% (95% CI: 70.5-90.8), a specificity of 92.5% (95% CI: 79.6-98.4), a positive predictive value of 94.4% (95% CI: 84.6-98.8), a negative predictive value of 77.1% (95% CI: 62.7-88.0), and a likelihood ratio of 11.0. In conclusion, the mean MPV of normal Thais may be used as a cutoff value in distinguishing these two types of thrombocytopenia.

A Retrospective Evaluation of Mean Platelet Volume as a Discriminating Factor in Thrombocytopenia of Hypoproductive and Hyperdestructive Aetiologies

“…4,10,11 However, the wider utility of this factor has yielded variable results. 4,5,12 In the present study, the cases with thrombocytopenia due to a bone marrow disease had a lower mean MPV while the other group without marrow involvement had a higher mean MPV. However, the difference between the groups was statistically not significant.…”

“…While the data on red blood size (mean corpuscular volume) is universally acknowledged and even applied, the diagnostic and prognostic utility of platelet size (mean platelet volume) in thrombocytopenia is still in its nascent stage of exploration. The recent years has seen a number of studies on mean platelet volume (MPV) as a factor to discriminate the cause of thrombocytopenia (Bowles et al 4 and Numbenjapon et al 5 ). Levine, et al 6 had proposed that the mechanism of thrombocytopenia could be simplified into two groups after excluding a splenic sequestration: hyperdestructive and hypoproductive.For a long time the bone marrow examination has remained the gold standard test in diagnosing the cause for thrombocytopenia.…”

Role of platelet indices in differentiating hypoproductive and hyperdestructive thrombocytopenia

“…[5,6] Further in manual method, a delay between collection of blood and smear preparation, may change the platelet morphology and also artefactual increase in platelet diameter can occur because of increased adhesiveness with flattening of the platelets on the smears. [7] Numbenjapon et al [8] found that MPV was significantly higher in hyperdestruction group compared to hypoproductive thrombocytopenia. In hyper destructive thrombocytopenia, bone marrow compensates actively for the platelet loss and start releasing young larger platelets ("left shift") which tend to decrease in size during its 7-10 days life span .…”

The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias

“…The mean platelet volume (MPV) assesses size of platelets;thus, a higher MPV is suggestive of a more immature platelet population. Most studies in adults have shown higher MPVs in patients with consumptive thrombocytopenias compared to etiologies of decreased platelet production 21 , 22 . However, the IPF is a more direct measure of immature platelets and is likely to correlate better with increased platelet production than the MPV.…”