Predictive Value Of Platelet Indices For Differentiating Hyper Destructive Thrombocytopenia From Hypo Productive Thrombocytopenia In Patients Attending Teritiary Care Hospital
Keywords:
Platelet indices, Thrombocytopenia, bone marrow
Abstract
BACKGROUND: Thrombocytopenia is one of the most critical and complicated clinical conditions to manage. Hence the need for a platelet count has increased over the years in the form of manual smear count and bone marrow examination for discriminating hyper destructive and hypo productive thrombocytopenia. The introduction of platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), Platelet large cell ratio (PLCR) in automated haematology analyzers has provided a window into the cause of thrombocytopenia in the recent years. Hence this study was undertaken to analyze the utility of these platelet indices in hypo productive and hyper destructive thrombocytopenia. METHODS: A prospective cross-sectional study was conducted on 84 thrombocytopenic patients out of which 49 were hyper destructive and 35 were hypo productive group. The blood samples were analyzed for CBC diff using SYSMEX XN 1000. Statistical analysis was performed to assess the mean SD, Receiver Operating Curve (ROC) to determine the specificity, sensitivity, positive predictive value (PPV) and negative predictive values (NPV) for platelet parameters. Correlation test to determine association between the continuous variables was done. RESULT: All platelet indices were significantly higher in hyper destructive than in hypo productive group. The MPV and PLCR showed better sensitivity and specificity, positive and negative predictive values when compared to PDW in both the groups. There was statistically significant correlation and difference of platelet parameters like MPV, PDW and PLCR between the hyper destructive and hypo productive thrombocytopenia. CONCLUSION: The platelet indices MPV and PLCR have better ability to discriminate hyper destructive from hypo productive thrombocytopenia. Evaluating these parameters offers an earlier diagnosis in hyper destructive thrombocytopenia patients avoiding, bone marrow aspiration and even prevent undesirable platelet transfusion.References
1. Hartwig J, Italiano J. The birth of the platelet. J Thromb Haemost. 2003 Jul;1(7):1580–6.
2. Ruchee khanna, Deepak Nayak M, Chetan Manohar, Murli Dhar."A retrospective evaluation of mean platelet volume as a discriminating factor in thrombocytopenia of hypo productive and hyper destructive aetiologies". Journal of evolution of medical and dental sciences 2013;2.47.9059-65
3. Sekhon SS, Roy V. Thrombocytopenia in Adults: A Practical Approach to Evaluation and Management. South Med J. 2006 May;99(5):491–8.
4. Lewis SM (Shirley M, Bain BJ, Bates I, Dacie JV (John V, Dacie JV (John V. Dacie and Lewis practical haematology. 10th ed. Philadelphia Penns.: Churchill Livingstone/Elsevier; 2006. 722 p.
5. Islam S, Islam MS, Ahmed MU, Aziz MA, Begum M. Role of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) value in the diagnosis of immune thrombocytopenic purpura. Hematol Transfus Int J 2016 ;2(2):1–4.
6. Kaito K, Otsubo H, Usui N, Yoshida M, Tanno J, Kurihara E, et al. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol. 2005;128(5):698–702.
7. Negash M, Tsegaye A, G/Medhin A. Diagnostic predictive value of platelet indices for discriminating hypo productive versus immune thrombocytopenia purpura in patients attending a tertiary care teaching hospital in Addis Ababa, Ethiopia. BMC Hematol. 2016 ;16:18.
8. Indices P, Khaleel KJ, Ahmed AA, Alwash M, Anwar A. Original paper Platelet indices and their relations to platelet count in hypo- productive and hyper-destructive Thrombocytopenia.2014;7(2):1952–8
9.Numbenjapon T, Mahapo N, Pornvipavee R, Sriswasdi C, Mongkonsritragoon W, Leelasiri A et al.A prospective evaluation of normal mean platelet volume in discriminating hyper destructive thrombocytopenia from hypo productive thrombocytopenia.Int J Lab Hematol.2008 oct;30(5):408-14.
10. Farweez B, Ibrahim R, Elsewefy D. Platelet indices: consideration in thrombocytopenia. Egypt J Haematol. 2014;39(3):134.
11. Khairkar PS, Pandey A, More S, Pandey M. Platelet Distribution Width (PDW) - A Rarely Studied Platelet Indice for Determining the Causes of Thrombocytopenia. Ann Int Med Dent Res. 2016;2(4).
2. Ruchee khanna, Deepak Nayak M, Chetan Manohar, Murli Dhar."A retrospective evaluation of mean platelet volume as a discriminating factor in thrombocytopenia of hypo productive and hyper destructive aetiologies". Journal of evolution of medical and dental sciences 2013;2.47.9059-65
3. Sekhon SS, Roy V. Thrombocytopenia in Adults: A Practical Approach to Evaluation and Management. South Med J. 2006 May;99(5):491–8.
4. Lewis SM (Shirley M, Bain BJ, Bates I, Dacie JV (John V, Dacie JV (John V. Dacie and Lewis practical haematology. 10th ed. Philadelphia Penns.: Churchill Livingstone/Elsevier; 2006. 722 p.
5. Islam S, Islam MS, Ahmed MU, Aziz MA, Begum M. Role of mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (P-LCR) value in the diagnosis of immune thrombocytopenic purpura. Hematol Transfus Int J 2016 ;2(2):1–4.
6. Kaito K, Otsubo H, Usui N, Yoshida M, Tanno J, Kurihara E, et al. Platelet size deviation width, platelet large cell ratio, and mean platelet volume have sufficient sensitivity and specificity in the diagnosis of immune thrombocytopenia. Br J Haematol. 2005;128(5):698–702.
7. Negash M, Tsegaye A, G/Medhin A. Diagnostic predictive value of platelet indices for discriminating hypo productive versus immune thrombocytopenia purpura in patients attending a tertiary care teaching hospital in Addis Ababa, Ethiopia. BMC Hematol. 2016 ;16:18.
8. Indices P, Khaleel KJ, Ahmed AA, Alwash M, Anwar A. Original paper Platelet indices and their relations to platelet count in hypo- productive and hyper-destructive Thrombocytopenia.2014;7(2):1952–8
9.Numbenjapon T, Mahapo N, Pornvipavee R, Sriswasdi C, Mongkonsritragoon W, Leelasiri A et al.A prospective evaluation of normal mean platelet volume in discriminating hyper destructive thrombocytopenia from hypo productive thrombocytopenia.Int J Lab Hematol.2008 oct;30(5):408-14.
10. Farweez B, Ibrahim R, Elsewefy D. Platelet indices: consideration in thrombocytopenia. Egypt J Haematol. 2014;39(3):134.
11. Khairkar PS, Pandey A, More S, Pandey M. Platelet Distribution Width (PDW) - A Rarely Studied Platelet Indice for Determining the Causes of Thrombocytopenia. Ann Int Med Dent Res. 2016;2(4).
Published
2020-04-02
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