ABSTRACT
Background: Thrombocytopenias can be categorised into hypoproliferative (group I) & hyperdestructive types (group II) based on their etiology. Platelet indices (MPV, PDW, P-LCR, platelet-crit) can be used to differentiate this type of thrombocytopenias & these are simple, cost-effective, noninvasive & reliable. The main objective of this study was to evaluate the efficiency of platelet indices to differentiate hypoproductive type from hyperdestructive thrombocytopenias. Methods: Automated Hematology Analyzer Sysmex XT-2000i used to assess platelet indices. 100 Cases of thrombocytopenia & age adjusted (similar age group) controls with normal CBC & peripheral blood smears were included in the study. The gender was not taken into account as the ranges of platelet indices are almost the same for boys & girls of similar age groups. Results: The platelet indices of group I was platelet count = (51.8 ± 31.6) x103/mm, MPV = (8.5 ± 1.27) fl, PDW = (14.10 ± 1.15) fl, P-LCR = (31.90 ± 3.46)%. The platelet indices of group II was platelet count = (39.6 ± 32.7) x103/mm, MPV = (11.6 ± 2.25) fl, PDW = (15.16 ± 1.36) fl, P-LCR = (34.30 ± 2.2)%. Comparative analysis of MPV, PDW & P-LCR of group I and group II showed p value <0.05 proving it to be statistically significant. Conclusions: The combined interpretation of MPV, PDW & P-LCR by automated cell counters can be very useful parameters in differentiating thrombocytopenias due to various etiologies. Platelet indices showed inverse relationship with platelet count as they are increased in hyperdestructive type & shows linear relationship in hypoproliferative type. MPV, PDW & P-LCR can be precisely used to differentiate hyperdestructive type (ITP) from hypoproliferative type (acute leukemias, aplastic anemias). Platelet-crit & platelet large cell ratio are less sensitive parameters to differentiate these thrombocytopenias.
ABSTRACT
Aims: This study aims to establish biological reference interval for novel platelet parameters. Settings and Design: A total of 945 healthy individuals, age ranges from 18 to 64 years (881 males and 64 females) coming for voluntary blood donation from June to August 2012 (3 months) were enrolled after exclusion of rejection criteria. Materials and Methods: The samples were assayed by running in complete blood count + reticulocyte mode on the Sysmex XE-2100 hematology analyzer and the reference interval for the population was calculated using Clinical and Laboratory Standards Institute guidelines. Statistical analysis used: Tests were performed using SPSS (Statistical Product and Service Solutions , developed by IBM corporation), version 13. Student t test and pearsons correlation analysis were also used. Results: The normal range for various parameters was platelet count: 150-520 × 103/cu mm, immature platelet fraction (IPF): 0.3-8.7%, platelet distribution width (PDW): 8.3-25.0 fL, mean platelet volume (MPV): 8.6-15.5 fL, plateletcrit (PCT): 0.15-0.62%, high immature platelet fraction (H-IPF): 0.1-2.7%, platelet large cell ratio (P-LCR): 11.9-66.9% and platelet-X (PLT-X) (ch): 11.0-22.0. Negative correlation was observed between platelet count (r = −0.468 to r = −0.531; P < 0.001) and PCT (r = −0.080 to r = −0.235; P < 0.05 to P < 0.001) with IPF, PDW, MPV, H-IPF, P-LCR, and platelet-X. IPF/H-IPF showed a positive correlation among them and also with PDW, MPV, P-LCR, platelet-X (r = +0.662 to r = +0.925; P < 0.001). Conclusions: These novel platelet parameters offer newer avenues in research and clinical use. Establishing biological reference interval for different platelet parameters would help determine true high and low values and help guide treatment decisions.
ABSTRACT
Objective To observe the changes in platelet parameters including platelet volume distribution width (PDW),plateletcrit (PCT) and platelet large cell ratio (PLCR) in patients with septic shock,and to approach its predictive effect on prognosis to obtain the indexes predicting the prognosis quickly and conveniently.Methods A retrospective study was conducted.Data from septic shock patients admitted to Peking Union Medical College Hospital from January 1 to December 31,2012 were collected.The patients were divided into two groups according to prognosis.The general condition,laboratory parameters,infection,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,and platelet parameters at 5 days after admission and 2 days before discharge from hospital,such as platelet count (PLT),Mean platelet volume (MPV),PDW,PCT and PLCR were recorded.Receiver operating characteristic curve (ROC curve) was drawn for those parameters and the area under curve was compared.Results A total 124 septic shock patients were enrolled finally,88 of the patients died and 36 remained alive.PDW and PLCR were elevated with the progress of the disease,the PLT and PCT were declined,and MPV maintained at a high level.The control group showed an opposite trend.MPV in non-survivor group was significantly higher than that in survivor group [fl:11.2 (10.5,12.5) vs.10.3 (9.7,11.0),relative risk (RR)=3.362,P=0.009].There was no significant difference in PLT,PDW,PCT and PLCR between non-survivor group and survivor group [PLT(× 109/L):105.0(47.5,191.5) vs.164.0 (85.0,236.0),RR=1.004,P=0.441; PDW:0.14 (0.12,0.17) vs.0.12 (0.11,0.13),RR=1.053,P=0.795;PCT:0.13 (0.07,0.21)％vs.0.18 (0.09,0.24)％,RR=0.234,P=0.747; PLCR:33.7 (28.1,42.8)％vs.26.8 (23.2,32.0)％,RR=0.924,P=0.324].ROC curve showed the best cutoff value for PLT was ＞487.0 × 109/L,with AUC of 0.377,sensitivity of 1.14％,specificity of 100％,diagnosis accuracy of 29.27％ and Youden index of 0.011; the best cutoff value for MPV was ＞ 10.5 fl,with AUC of 0.812,sensitivity of 81.82％,specificity of 65.71％,diagnosis accuracy of 75.61％ and Youden index of 0.475; the best cutoff value for PLCR was ＞39.3％,with AUC of 0.758,sensitivity of 48.86％,specificity of 91.43％,diagnosis accuracy of 60.98％ and Youden index of 0.403;the best cutoff value for PCT was ＞0.33％,with AUC of 0.380,sensitivity of 7.96％,specificity of 97.14％,diagnosis accuracy of 32.52％ and Youden index of 0.051 ; the best cutoff value for PDW was ＞0.12,with AUC of 0.747,sensitivity of 82.96％,specificity of 57.14％,diagnosis accuracy of 74.80％ and Youden index of 0.401.Conclusions Different change trends of platelet parameters can be seen between the non-survivors and survivors of septic shock patients.If PDW,PLCR and MPV show increased trend while PLT and PCT show decreased trend,a poor prognosis maybe indicated.MPV may be most useful in prognosis forecast because of its biggest AUC.