Assessment of Qualitative and Quantitative Changes in 5 days stored Platelet Concentrates in Bangabandhu Sheikh Mujib Medical University

Background: The fast-growing demand for platelet concentrates (PC) necessitates the storage of these blood products before transfusion. Platelets are prepared as concentrates from the whole blood or by plateletpheresis. Qualitative and quantitative assessment of these PCs is an important issue in transfusion medicine. To assess the qualitative, quantitative changes and bacteriological safety of 5 days of stored platelet concentrates (PC).Material & Methods:This prospective study was conducted at the department of Clinical Pathology in collaboration with the Department of Transfusion Medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from April 2008 to April 2009. A total of 65 healthy donors were included in the study as per the inclusion and exclusion criteria. Therefore, 65 platelet concentrates (bags/units) were prepared from the donors. Purposive sampling of the units was done. pH and platelet indices (PLT, MPV, PDW and P-LCR) were measured and Gram staining of PCs was performed on days 0 and 5. Statistical significant tests were done at a 95% confidence interval using the statistical package for social science (SPSS).Results:The mean (±SD) pH was 7.18±0.07 ranging from 7.0 to 7.3 during day 0. On day 5 the mean (±SD) pH was 6.77±0.11 and their range was from 6.5 to 7. The mean pH difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) PLT/unit was 70.56±15.56 x109/unit and it ranged from 38.01 to 110.6 x109/unit during day 0. On day 5 the mean (±SD) PLT/unit level was 68.46±15.52 x109/unit and it ranged from 36.82 to 107.2 x109/unit. The mean PLT/unit difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) MPV was 9.34±0.92 fl and it ranged from 7.5 to 11.5 fl during day 0. During day 5 the mean (±SD) MPV was 9.27±0.99 fl ranging from 7.0 to 11.2 fl. The mean (±SD) PDW was 10.07±1.61 fl and which ranged from 7.4 to 14.4 fl during day 0. During day 5 the mean (±SD) PDW was 10.72±1.71 fl ranging from 7.0 to 15.4 fl. The mean (±SD) PLCR was 18.28±5.67 % and it ranged from 8.0 to 32.5 % during day 0. During day 5 the mean (±SD) PLCR was 21.18±5.91 % and it ranged from 10.0 to 36.3 %. The mean PLT, PDW and PLCR differences were statistically significant (p<0.05) between day 0 and day 5 in the unpaired t-test, however, the mean MPV difference was not statistically significant (p<0.05) between day 0 and day 5. Gram staining of platelet concentrates on day 0 and day 5 found no bacteria.Conclusions:Storage-induced lesions take place in PCs when stored for 5 days in second-generation storage containers under the currently recommended conditions, but how far these changes are clinically relevant needs to be investigated.

Assessment of Qualitative and Quantitative Changes in 5 days stored Platelet Concentrates in a tertiary care Hospital of Bangladesh

Background: The fast growing demand for platelet concentrates (PC) necessitates the storage of these blood products prior to transfusion. Platelets are prepared as concentrates from the whole blood or by plateletpheresis. Qualitative and quantitative assessment of these PCs are an important issue in transfusion medicine. Aim of the study: To assess the qualitative, quantitative changes and bacteriological safety of 5 days stored platelet concentrates (PC).Material & Methods:This prospective study was conducted at the department of Clinical Pathology in collaboration with the department of Transfusion medicine, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during April 2008 to April 2009. A total of 65 healthy donors were included for the study as per the inclusion and exclusion criteria. Therefore, 65 platelet concentrates (bags/units) were prepared from the donors. Purposive sampling of the units was done. pH and platelet indices (PLT, MPV, PDW and P-LCR) were measured and Gram staining of PCs were performed on day 0 and 5. Statistical significant tests were done at 95% confidence interval using statistical package for social science (SPSS).Results:The mean (±SD) pH was 7.18±0.07 ranging from 7.0 to 7.3 during day 0. During day 5 the mean (±SD) pH was 6.77±0.11 and their range was from 6.5 to 7. The mean pH difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) PLT/unit was 70.56±15.56 x109/unit and it ranged from 38.01 to 110.6 x109/unit during day 0. During day 5 the mean (±SD) PLT/unit level was 68.46±15.52 x109/unit and it ranged from 36.82 to 107.2 x109/unit. The mean PLT/unit difference was statistically significant (p<0.05) between day 0 and day 5. The mean (±SD) MPV was 9.34±0.92 fl and it ranged from 7.5 to 11.5 fl during day 0. During day 5 the mean (±SD) MPV was 9.27±0.99 fl ranging from 7.0 to 11.2 fl. The mean (±SD) PDW was 10.07±1.61 fl and which ranged from 7.4 to 14.4 fl during day 0. During day 5 the mean (±SD) PDW was 10.72±1.71 fl ranging from 7.0 to 15.4 fl. The mean (±SD) PLCR was 18.28±5.67 % and it ranged from 8.0 to 32.5 % during day 0. During day 5 the mean (±SD) PLCR was 21.18±5.91 % and it ranged from 10.0 to 36.3 %. The mean PLT, PDW and PLCR difference were statistically significant (p<0.05) between day 0 and day 5 in unpaired t-test, however the mean MPV difference was not statistically significant (p<0.05) between day 0 and day 5. Gram staining of platelet concentrates on day 0 and day 5 found no bacteria.Conclusions:Storage-induced lesions take place in PCs, when stored for 5 days in second generation storage containers under the currently recommended conditions, but how far these change are clinically relevant need to be investigated

Practical Approach to the Interpretation of Complete Blood Count Reports and Histograms

Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.

COVID-19 in Pregnancy: Implication on Platelets and Blood Indices / COVID-19 na gravidez: implicações nas plaquetas e índices sanguíneos

Abstract Objective To describe the hematological changes, the platelet indices in particular, in pregnant women with coronavirus disease 2019 (COVID-19) compared to healthy pregnant women. Methods A retrospective case-control study conducted at the Al Yarmouk Teaching Hospital, in Baghdad, Iraq, involving 100 pregnant women, 50 with positive viral DNA for COVID-19 (case group), and 50 with negative results (control group); both groups were subjected to a thorough hematological evaluation. Results Among the main hematological variables analyzed, the platelet indices, namely the mean platelet volume (MPV) and the platelet distribution width (PDW), showed statistically significant differences (MPV: 10.87±66.92 fL for the case group versus 9.84±1.2 fL for the control group; PDW: 14.82±3.18 fL for the case group versus 13.3±2.16 fL for the controls). The criterionvalue of the receiver operating characteristic (ROC) curve forPDWat a cutoffpoint of>11.8 fL showed a weak diagnostic marker, while the MPV at a cutoff value of>10.17 fL showed a good diagnostic marker. Conclusion The MPV and PDW are significantly affected by the this viral infection, even in asymptomatic confirmed cases, and we recommend that both parameters be included in the diagnostic panel of this infection.

Resumo Objetivo Descrever as alterações hematológicas, em particular os índices plaquetários em gestantes com doença coronavírus 2019 (COVID-19) em comparação com gestantes saudáveis. Métodos Estudo caso-controle retrospectivo realizado no Hospital Universitário Al Yarmouk, em Bagdá, Iraque envolvendo 100 gestantes, 50 com DNA viral positivo para COVID-19 (grupo caso) e 50 com resultados negativos (grupo controle); ambos os grupos foram submetidos a uma avaliação hematológica completa. Resultados Entre as principais variáveis hematológicas analisadas, os índices plaquetários, nomeadamente o volume plaquetário médio (VPM) e a largura de distribuição plaquetária (PDW), apresentaram diferenças estatisticamente significativas (VPM: 10,87±66,92 fL para o grupo caso versus 9,84±1.2 fL para o o grupo controle; PDW: 14,82±3,18 fL para o grupo caso versus 13,3±2,16 fL para os controles). O valor de critério da curva de característica de operação do receptor (ROC) para PDW em um ponto de corte de> 11,8 fL mostrou um marcador diagnóstico fraco, enquanto o do VPM emumvalor de corte de> 10,17 fL mostrou um bom marcador de diagnóstico. Conclusão OMPVe PDWsão significativamente afetados por esta infecção viral, mesmo em casos confirmados assintomáticos, e recomendamos que ambos os parâmetros sejam incluídos no painel de diagnóstico desta infecção.

Evaluation of platelet indices and complete blood count in canine mammary tumors

Malignant mammary tumors in humans and bitches cause hematological disorders such as anemia, erythrocytosis, thrombocytosis, hyperproteinemia, and leucopenia. Novel studies have been conducted on the predictive and prognostic values of platelet (PLT) indices in human breast cancer (HBC). However, there is little information about the alterations in hematological parameters in canine mammary tumors (CMTs). The aims of this study were to evaluate the platelet indices and complete blood count (CBC) parameters in bitches with and without mammary tumor and to assess the above mentioned parameters with regard to histological tumor types and grades. A total of 71 bitches were enrolled in this study. The bitches in the study group were divided into 2 groups which consisted of malignant epithelial mammary tumors (group EMT; n = 43) and malignant mixed mammary tumors (group MMT; n = 12). Control group (group C) consisted of clinically and gynaecologically healthy 16 bitches. Blood samples were obtained to perform the CBC and PLT indices analysis. Histopathological examinations were carried out under a light microscope. Histological tumor types and malignancy grades were classified. The bitches with mammary tumor showed significantly increased PLT values and decreased hematocrit (HCT), hemoglobin (HGB) and mean corpuscular hemoglobin (MCH) values versus the healthy ones, regardless of the tumor type. However, in comparisons with the group C, mean platelet volume (MPV) and mean corpuscular hemoglobin concentration (MCHC) values were different only in the group MMT, while plateletcrit (PCT) and mean corpuscular volume (MCV) values were different only in the group EMT. Also white blood cell (WBC), PLT and PCT values were higher than the referenced laboratory ranges in grade 3 tumors. In the presented study, MPV was considerably correlated with PLT, platelet distribution width (PDW) and PCT. Also, PCT and PLT had high sensitivity and specificity to distinct EMT and MMT from the healthy bitches. Microcytic and hypochromic anemia occurs due to the decrease in the amount of HGB. Levels of MCV, MCH, and MCHC in the HBC group were reported to be significantly lower than in humans without breast cancer. Although anemia did not occur in EMT and MMT groups, obtained significances in the HCT, HGB, MCV, MCH, and MCHC levels between the bitches with and without mammary tumor were in line with the previous reports. In this study, WBC levels in grade 3 tumors were significantly higher than grade1 tumors (P < 0.05). Whereas levels of WBC in grade 1 and grade 2 tumors were in referenced laboratory ranges, it was higher in grade 3. Increased level of WBC in grade 3 was supposed to be due to the rise in malignancy as previously reported. Thrombocytosis was detected in 48.83% and 41.66% of the bitches in EMT and MMT groups, respectively. The higher percentage of CMTs with thrombocytosis in this study might be due to the difference in referenced upper limit of PLT in previous studies. The elapsed time between tumor formation and clinical presentation could be another influencing factor. Although PLT and PCT values were not significant according to the histological grading in this study, both parameters were found to be higher in grade 3 than the normal reference values. Further studies conducted with higher populations may lead the differences in these parameters to significance. With the support of further studies, alterations in the above mentioned parameters in bitches may contribute in the diagnosis process, management of treatment and may constitute an easy way to have an idea about the prognosis of mammary tumors.(AU)

Role of platelet distribution width and plateletcrit in assessment of nonthrombocytopenic preeclampsia and eclampsia in a tertiary care hospital of Odisha: an observational study

Background: Preeclampsia (PE) is a major cause of maternal and foetal morbidity and mortality in pregnancy. A decreased platelet count is observed during the progression of preeclampsia, and is considered a marker of the severity of preeclampsia. Considering the role of the PDW, PCT and platelet indices during the disease, the aim of this study was to evaluate the feasibility of using platelet indices as a severity marker for PE.Methods: This was a prospective, observational study, hospital-based study, from 2017-19 with 400 pregnant women being included on the basis of a predefined inclusion and exclusion criteria, through antenatal clinic, and labour room of the department of obstetrics and gynecology, S. C. B. Medical College, Cuttack, Odisha, India.Results: Study found that platelet count and plateletcrit showed a significant negative correlation with MAP whereas platelet distribution width showed a maximum positive correlation. In the preeclampsia group, subjects with PCT <0.22% were at risk of developing severe disease with a sensitivity of 53.5% and a high specificity of 85.5%. The AUC of 0.75 showed that it has a good predictability. In the eclampsia group, subjects with PCT <0.16% had a risk of developing severe disease with a sensitivity of 89.5% and specificity of 73.7%. The AUC 0.9 shows PCT to be a good predictor for assessing severity of eclampsia.Conclusions: This study suggests that platelet distribution width and plateletcrit are useful in risk evaluation of preeclampsia. These are a valid measurement tool to predict the severe progression of PE even when normal platelet counts are observed.

A review of relationship between platelet indices and microvascular complications in type 2 diabetic patients

Diabetes is a common metabolic disorder affecting the world population which accounts for major amount of morbidity and mortality mainly due to its micro vascular and macro vascular complications. This is a comparative study which analyses the correlation between the Platelet indices like Mean platelet volume, platelet distribution width, plateletcrit and total platelet count in diabetic patients with micro vascular complications and without complications. This review of the literature was conducted through an Internet search on a public access website like PubMed Google scholar, Medline databases until 2019. Keywords utilized included Diabetes mellitus, Microvascular complications, platelet indices. The major exclusion criteria was studies which included the patients with macrovascular complications and patients taking drugs which alters the platelet indices. All these articles were analysed. Platelet indices like Mean platelet volume and platelet distribution width was significantly higher in individuals with microvascular complications, predominantly Diabetic Nephropathy and Diabetic Retinopathy when compared to those without microvascular complications. Change in platelet indices were found to be statistically associated with diabetic microvascular complications. Hence these parameters can be used to monitor and to predict the risk of microvascular complications.

Platelet count as a novel potential predictor of periprosthetic joint infection / 中国组织工程研究

BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94% and 86.13%, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.

Platelet count as a novel potential predictor of periprosthetic joint infection / 中国组织工程研究

BACKGROUND: Obtaining synovial fluid for diagnostic test of periprosthetic joint infection is invasive and painful to patients. Platelet count is a regular blood test which has been used as a possible predictor of several infectious diseases. Presumably, it could be one of the indicators of periprosthetic joint infection. OBJECTIVE: To identify the accuracies of platelet combined with white blood cell, erythrocyte sedimentation rate or C-reactive protein in the diagnosis of periprosthetic joint infection. METHODS: Patients undergoing revision arthroplasty from March 2013 to December 2018 in the First Affiliated Hospital of Guangzhou University of Chinese Medicine were retrospectively enrolled. A diagnosis of periprosthetic joint infection was confirmed in 77 patients according to the criterions from the Musculoskeletal Infection Society; the remaining 137 patients were confirmed as aseptic cases. White blood cell, erythrocyte sedimentation rate, or C-reactive protein and platelet count were compared between the two groups. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS AND CONCLUSION: The platelet values were significantly increased in periprosthetic joint infection cases. Sensitivity and specificity of the platelet for periprosthetic joint infection were 64.94％ and 86.13％, respectively. Platelet demonstrated a higher accuracy when compared to erythrocyte sedimentation rate and C-reactive protein. In such cases, the platelet shows a certain reference value in confirming the diagnosis of periprosthetic joint infection. Platelet was enough used as adjunct diagnostic tool in patients suspected with periprosthetic joint infection.

Changes in Platelet Indices in Obese and Non-Obese Individuals in a Tertiary Healthcare Facility in Uyo, Nigeria

Background: Obesity is associated with significant cardiovascular and thromboembolic risk largely due to increased plateletreactivity. Objectives: To determine the changes in platelet counts and platelet activation using platelet indices (MPV & PDW) inobese and non-obese patients in a tertiary hospital in Uyo, Nigeria.Methodology: This was a cross-sectional descriptive studycomprising of 191 participants recruited consecutively from the out-patients Departments of University of Uyo Teaching Hospitalover a six months period (March-August 2018). Patients were categorised into obese, overweight and normal weight based ontheir Body Mass Index (BMI). Also, 2.5mls of blood was collected from each patient and same was used to determine full bloodcount from where the platelet count and platelet indices (MPV & PDW) were obtained. Results: There was progressive increasein the mean platelet count of the patients (210.59 ± 51.6, 194.26 ± 49.8, 184.95 ± 51.7 for obese, overweight and normal weightrespectively) and this increase was statistically significant (P=0.0208). However, the mean platelet indices (MPV & PDW) wasnot statistically significant (P=0.351 and 0.933 for MPV and PDW respectively). Conclusion: Platelet counts was significantlyelevated in obese patients compared with the overweight and normal weight however, the MPV and PDW was not significantlydifferent in the three groups.

The role of platelet indices in ischemic heart disease: a hospital based case control type of study

Background: In developing countries, Ischemic heart diseases (IHD) is one of the leading causes of morbidity and mortality. The underlying pathology of CAD is atherosclerosis. When this atherosclerotic plaque ruptures, platelets play a crucial role in the prothrombotic events and forms a thrombus on this plaque and as a result coronary artery gets occluded causing ischemia and infarction. Platelet contains many chemokines, cytokines and growth factors. Release of these factors along with interaction with endothelial cells and leukocytes promotes inflammation and progression of atherosclerosis. We aimed to investigate the association between platelet volume indices in patients with diagnosis of Ischemic heart disease in comparison with control group.Methods: By using automated cell counter platelet count and platelet volume indices - were compared with Normal healthy or non-cardiac chest pain patients with the use of unpaired t test.Results: In the present study, we demonstrated that platelet count is significantly low and MPV and PDW are significantly high in Ischemic heart disease as compared to patients with noncardiac chest pain or healthy subjects. The correlation of MPV with PC revealed an inverse correlation between the patients of IHD and healthy or non-cardiac chest pain patients which is statistically significant.Conclusions: The platelet volume indices are an important, simple, effortless and a cost-effective tool useful in predicting the development of an acute coronary event sometimes in the near future and therapeutic modification for improved patient’s cardiovascular care.

Analysis of complete blood counts in rotaviral gastroenteritis with special emphasis on platelet indices

Background: The objectives of this study was to analyze complete blood counts in rotaviral gastroenteritis with special emphasis on platelet indices.Methods: Children diagnosed as rotavirus gastroenteritis and healthy controls were enrolled in this study. Severity of acute gastroenteritis was classified into mild, moderate and severe grades using Vesikari score. Rotavirus was determined in fresh stool samples using rapid diagnostic rotavirus antigen test. Hemoglobin, leukocyte, neutrophil to lymphocyte percentage ratio, platelet counts, mean platelet volume (MPV), platelet distribution width (PDW) and platelet crit (PCT) levels were assessed for all children. It's a case control study conducted at Pediatric Speciality Hospital.Results: There were 30 cases with mean age 1.58 years. Healthy controls were 30 with mean age 2.10 years. Mean Hb was lower in cases. Mean of platelet counts was higher in cases. Mean MPV levels was lower in cases. Mean PCT value was higher in cases. Mean MPV to platelet ratio value was lower in cases. All parameters values showed no significant difference among mild, moderate and severe groups of rotaviral gastroenteritis cases. Platelet count was negatively correlated with Hb, MPVP and positively correlated with TLC and PCT. MPV was positively correlated with MPVP and PDW. PCT was negatively correlated with Hb, MPVP and positively correlated with TLC and platelet count.Conclusions: MPV can be used as negative acute phase reactant in rotavirus gastroenteritis and so is the MPV to platelet ratio. Platelet count is acute phase reactant in rotavirus gastroenteritis and so is the platelet crit value.

Study of hematological parameters in sepsis patients and its prognostic implications

Background: Septic response is a leading contributory factor for morbidity and mortality especially in intensive care settings. The current research aims to study the co-relation of various hematological parameters in sepsis patients with the objective to see their effects in prognosis of sepsis patients.Methods: The current study was a cross-sectional study with a sample size of 117 patients with sepsis. Various hematological parameters of all the patients were obtained on day of admission (day 1) and seventh day (day 7) using hemogram reports and the difference of their statistical mean and standard deviation was estimated.Results: There was a significant statistical difference in the mean and standard deviation of neutrophil lymphocyte count ratio (NLCR), red cell distribution width standard deviation (RDW SD), Platelet count (PLT) and Platelet crit (PCT) whereas Mean platelet volume (MPV), Platelet distribution width (PDW) and Platelet large cell ratio (PLCR) showed no significant changes on day 1 and day 7 of observation in patients taken for the study.Conclusions: The prognosis of sepsis can be important when we can clinch the hemogram markers early in the period of sepsis and evaluate them according to the etiology of the respective incidences. Targeted approach can be initiated early in the course of hospitalization and may be a specific index of hemogram could be established to further co relate sepsis and its form in particular diseases.

Can Platelet Large Cell Ratio and High-sensitivity Creactive Protein be used as Predictive Markers for Vascular Complications in Type 2 Diabetes Mellitus?

Background and Aims:A large proportion of patients with diabetes mellitus suffer from preventable vascular angiopathies. Alteredplatelet structure and functions have been linked with these vascular complications. Hence, this study was undertaken to correlateplatelet indices and high-sensitivity C-reactive protein (hs-CRP) levels with glycemic control and vascular complications to assesswhether they can be used as predictive factors.Materials and Methods: A total of 56 non-diabetics (control) and 145 diabetic patients were enrolled in this study. Criteria of fastingblood glucose ?126 mg/dL/postprandial plasma glucose (2 h) levels >200 mg/dL/HbA1c ?6.5 were considered. The diabetic groupwas further subdivided into diabetics without (82) and with complication (63) on the basis of clinical presentation, investigation, andexamination. Platelet indices (mean platelet volume [MPV], platelet distribution width [PDW], and platelet large cell ratio [P-LCR])were assessed on complete blood count analyzer. hs-CRP was done qualitatively and those samples which tested positive were assessedquantitatively.Observation: All the three platelet indices assessed - MPV, PDW, and P-LCR were significantly higher in diabetics compared to nondiabetic group and increased with increasing HbA1c level. However, only P-LCR showed a significant difference between diabetics withand without complications (P = 0.002) and MPV showed a significant difference among all the subgroups when correlated with HbA1c(P ? 0.04). For hs-CRP, the difference in the values was significant among the diabetics with and without complications (P = 0.01).Conclusion: A continuous increase in the value of MPV, PDW, and P-LCR with decreasing glycemic control proves that in diabeticsongoing inflammation causes persistent generation of larger platelets with enhanced activity. P-LCR should be the indice of choice forpredicting the possibility of future complication as in our study, it was the only parameter which showed significant difference betweendiabetics with and without complications

Evaluation Of Thrombocytopenia In The Pediatric Patients By Platelet Indices: A Study In A Tertiary Care Hospital.

Background: Evaluation of thrombocytopenia involves a meticulous approach in which complete clinical history, clinical examination, complete hemogram and bone marrow aspiration if indicated, are included. The various platelet indices produced by the automated analysers such as, Mean platelet volume (MPV), Platelet distribution width (PDW), Plateletcrit (PCT) and Large cell ratio (LCR) can be used to distinguish the underlying etiology of thrombocytopenia. Methods: Total of seventy three thrombocytopenic patients <14 years with proper clinic-hematological work up were included in the study. The results were compared by manual examination of the peripheral blood smear. Results: Patients were grouped based on the mechanism- Peripheral destruction 54 (73.9%), Hypoproduction 10 (13.6%), Hypersplenism 9 (12.3%). There was a linear correlation between the platelet count and all the platelet derived indices (MPV, PDW, PCT, LCR) in the patients with peripheral destruction of platelets.The p-value of all the derivatives was statistically significant (level of significance less than 0.05). In patients with hypoproduction and hypersplenism,there was positive correlation between the platelet count and MPV, PDW, PCT & LCR. None of the pvalues were statistically significant. Conclusions: Platelet indices especially MPV and PDW can be used as important initial and supportive tool to differentiate between the hyperdestructive versus hypoprodution and hypersplenism cases.

Evaluation of platelet indices among patients with exacerbation of COPD in a tertiary care center in South India

Introduction: Mean platelet volume (MPV) and Platelet Distribution Width (PDW) is a relatively simple, inexpensive tool that indicates the platelets size, the rate of platelet production, platelet activation and the severity of inflammation since inflammation plays an important role in COPD, any alteration in platelet activity can cause alteration in MPV. Red blood cell distribution width (RDW) reflects morphology of erythrocytes whereas RDW can also vary due to systemic inflammation and ineffective erythropoiesis. Hence we aimed to study Platelet indices in patients with exacerbation of COPD. Aim and objectives: Our aim is to evaluate the role of platelet Indices in COPD patients. Since only limited data were available on the relationship between COPD and platelet indices, we aimed to evaluate and find out the correlation between Mean Platelet Volume (MPV), Red Cell Distribution Width (RDW), Platelet Distribution Width (PDW) and Plateletcrit (PCT) in exacerbation of COPD patients at a tertiary care hospital in south India. Materials and methods: A total of 135 subjects, 79 men and 56 women, who were admitted in our hospital with exacerbation of COPD during a period of one year were enrolled in this prospective Ragulan R, Viswambhar V, Krishnaveni R, Meenakshi Narasimhan, Aruna Shanmuganathan, Nisha Ganga, Gangaiamaran M. Evaluation of platelet indices among patients with exacerbation of COPD in a tertiary care center in South India. IAIM, 2017; 4(7): 161-166. Page 162 observational study. The levels of MPW, RDW, PDW and PCT were assessed during the course of hospital stay in patients with COPD exacerbation Results: In our study we found out that there exists a statistical significance among male and female COPD exacerbation patients with respect to Mean Platelet Volume (P=<0.0001) and Red Cell Distribution Width (P=<0.0001). There also exists statistical significance between our COPD patients with other study stable controls (p=<0.005). Using ROC curve, considering optimal level of MPV <8.8Fl, male population showed sensitivity of 95% and specificity of 85% with Average age in men with diagnosed COPD is 49 and average age of female COPD patient is 55. Conclusion: Our study suggests that Mean Platelet Volume and Red Cell Distribution Width values may be useful for identifying patients who are at high risk for exacerbation of COPD. RDW per se is an important risk factor for Ischemic heart disease (IHD) and elevated RDW may suggest increase in risk of IHD in patients with COPD

Platelet Distribution Width (PDW) - A Rarely Studied Platelet Indice for Determining the Causes of Thrombocytopenia.

Background: Thrombocytopenia (TCP) is low platelets count, which is either due to defective platelet production or due to increased platelet breakdown. The platelet number alone does not give a complete picture of platelet maturity and function, therefore, the platelet indices have been the subject of intensive study in recent years, but they have not been firmly established. Mean platelet volume (MPV) and platelet distribution width (PDW) are useful parameters in evaluating disorders of platelets. This study was undertaken to evaluate the effectiveness of PDW in diagnosing causes of thrombocytopenia. Methods: 510 cases of thrombocytopenia and 500 cases of Control group with normal platelet count were included in the study. TCP was defined as platelet counts below 1.5 lacs/cumm. Hematological analysis was done on Mindray BC-3000 plus automated hematology analyzer. All cases were reevaluated by peripheral smear examination. Only those cases were included in the study, which showed platelet count and platelet volume parameters with graph both in cases and in control group. Results: Hyper-destructive group constituted majority of the cases 352 (69%), while hypo-productive group and abnormal pooling constituted 30% and 1.42% cases respectively. The mean PDW was significantly higher in hyper-destructive group when compared with hypo-productive group, Abnormal pooling and control group. The difference was statistically significant. Conclusion: PDW provides plenty of clinical information about the causes and patho-mechanisms of thrombocytopenia and could be helpful to distinguish hyper-destructive thrombocytopenia from hypo-productive thrombocytopenia. More attention should be paid to PDW along with other platelet indices to differentiate between hyper-destructive TCP from hypo-productive and abnormal pooling TCP.

A study on platelet indices and platelet membrane glycoprotein in children with primary immune thrombocytope-nia / 临床儿科杂志

ObjectiveTo investigate the change of the platelet function in children with primary immune thrombocy-topenia (ITP) before and after treatment.MethodsThe platelet indices, immature platelet fraction (IPF%), immature platelet counts (IPC), granule membrane glycoproteins of platelet (CD62p, PAC-1, CD42b) were tested by automatic blood cell analyzer and lfow cytometry (FCM) in 18 children with ITP before treatment and after complete response and in 17 children undergoing elective surgery (control gourp).ResultsCompared with control group, MPV, PDW, P-LCR and IPF% were signiifcantly higher and PLT, PCT, IPC were signiifcantly lower in children with ITP. The expressions of three platelet membrane glycoproteins (PAC-1, CD62p, CD42b) were signiifcantly lower in children with ITP. After treatment, children with ITP achieved completely response. Compared with before treatment, MPV, PDW, P-LCR and IPF% were signiifcantly lower, and PLT, PCT, IPC, and the expressions of three platelet membrane glycoproteins (PAC-1, CD62p and CD42b) were significantly higher. ConclusionsThe platelet function is depressed and in status of low activity in children with ITP. The relative platelet indices provide new references for the diagnosis and the judgment of therapeutic effect in ITP patients.

Association Between High Platelet Indices and Proteinuria in Patients With Hypertension

BACKGROUND: We aimed to determine the association between platelet indices including plateletcrit (PCT), mean platelet volume (MPV), platelet distribution width (PDW), and proteinuria associated with hypertension (HT) as well as the relative power of each to predict proteinuria. METHODS: The study included 223 patients (68 men and 155 women) with primary HT. PCT, MPV, PDW, and proteinuria levels were measured. The patients were divided into two groups according to proteinuria status based on 24-hr urinary protein excretion: proteinuria (+) group (15 men and 40 women) and proteinuria (-) group (53 men and 115 women). RESULTS: The mean and SD of platelet count, PDW, PCT, and MPV were 278.8+/-49.6x10(9)/L, 13.5+/-1.8%, 0.31+/-0.07%, and 11.3+/-2.6 fL, respectively. The mean platelet count, PCT, MPV, and PDW were significantly higher in the proteinuria (+) group than in the proteinuria (-) group (P<0.05); there were no significant differences in the other blood parameters between the two groups. The platelet count, PCT, MPV, and PDW were independent risk factors predictive of proteinuria according to a stepwise regression analysis of PDW, PCT, and MPV. PCT was the strongest independent predictor of proteinuria. CONCLUSIONS: The platelet indices PCT, PDW, and MPV were significantly higher in patients with proteinuria than in those without it. Among these three indices, PCT was the strongest predictor of proteinuria.

Valoración de índices plaquetarios en las trombocitopenias / Valuation of platelet índices in thrombocytopenia / Avaliagáo de índices plaquetários nas trombocitopenias

El objetivo de este trabajo fue determinar la utilidad clínica de los índices plaquetarios en la caracterización etiológica de las trombocitopenias. Se trata de un estudio descriptivo, retrospectivo y transversal. En pacientes controles se establecieron valores de referencia para número de plaquetas e índices plaquetarios, y éstos se evaluaron en pacientes donde coexistía trombocitopenia con algún desorden oncohematológico (linfoma no Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásico, púrpura trombocitopénica inmune). La evaluación de laboratorio fue realizada al momento del diagnóstico, aún libre de tratamiento. En los casos de Púrpura Inmune (disminución de Volumen Plaquetario - Plaquetocrito, y aumento de Amplitud Plaquetaria); Leucemia Mieloide Crónica (aumento de la Amplitud Plaquetaria) y Linfoma no Hodgkin o Síndrome Mielodisplásico (disminución del Plaquetocrito), los índices plaquetarios podrían ser usados como herramienta diagnóstica orientadora. En cambio, no podrían contribuir al momento de diferenciar entre leucemias agudas, dado que no presentan diferencias significativas. Frente a un diagnóstico presuntivo de síndrome mielodiasplásico o leucemia mieloide aguda, el valor de Volumen Plaquetario Medio (VPM) podría contribuir como herramienta orientadora al diagnóstico, ya que sería más bajo en la leucemia aguda. El análisis de los resultados sugiere que en la práctica clínica los índices plaquetarios podrían contribuir de un modo significativo a la confirmación del diagnóstico.

The aim of this study was to determine the clinical utility of platelet indices in the etiological characterization of thrombocytopenia. It was a descriptive, retrospective and cross-sectional study. In control patients, reference values (platelet count and platelet indices) were established and they were used to assess platelet indices in patients where thrombocytopenia coexisted with some oncohematologic disorders (non-Hodgkin Lymphoma, Hodgkin Lymphoma, acute leukemia, chronic leukemia, myelodysplastic syndrome, immune thrombocytopenic purpura). Laboratory evaluation was performed at still treatment-free diagnosis. In the cases of Immune Purpura, (decreased platelet volume- plateletcrit, and increased platelet distribution width) Chronic Myeloid Leukemia (increased platelet distribution width) and non-Hodgkin lymphoma or myelodysplastic syndrome (decreased plateletcrit), platelet indices could be used as a "guiding diagnostic tool". However, they could not contribute to the differenciation between acute leukemias since they do not present any significant differences. In view of a presumptive diagnosis of mielodysplastic syndrome or acute myeloid leukemia, mean platelet value (MPV) could contribute to the diagnosis, since it would be lower in acute leukemia. The analysis of the results suggests that in clinical practice, platelet indices may contribute significantly to the confirmation of the diagnosis.

O objetivo deste trabalho foi determinar a utilidade clínica dos índices plaquetários na caracterizagáo etiológica das trombocitopenias. Trata-se de um estudo descritivo, retrospectivo e transversal. Em pacientes controle foram estabelecidos valores de referencia para número de plaquetas e índices plaquetários, e eles foram avaliados em pacientes onde coexistia trombocitopenia com alguma desordem onco-hematológica (linfoma náo Hodgkin, linfoma Hodgkin, leucemia aguda, leucemia crónica, síndrome mielodisplásica, púrpura trombocitopenia imune). A avaliagáo de laboratório foi realizada no momento do diagnóstico, ainda livre de tratamento. Nos casos de Púrpura Imune (diminuigáo de Volume Plaquetario - Plaquetócrito, e aumento de Amplitude Plaquetária); Leucemia Mieloide Crónica (aumento da Amplitude Plaquetária) e Linfoma náo Hodgkin ou Síndrome Mielodisplásica (diminuigáo do Plaquetócrito), os índices plaquetários poderiam ser usados como ferramenta diagnóstica orientadora. Entretanto, náo poderiam contribuir no momento de diferenciar entre leucemias agudas, visto que náo apresentam diferengas significativas. Diante de um diagnóstico presuntivo de síndrome mielodiasplásica ou leucemia mieloide aguda, o valor de Volume Plaquetário Médio (VPM) poderia contribuir como ferramenta orientadora para o diagnóstico, devido a que seria mais baixo na leucemia aguda. A análise dos resultados sugere que na prática clínica os índices plaquetários poderiam contribuir de um modo significativo para a confirmagáo do diagnóstico.