Original Research Article

Relationship between mean platelet volume and platelet count: A prospective study in healthy adult population

Udasimath Shivakumarswamy1*, Purushotham R2, Nagesha K R3

1,2Associate Professor, 3Professor and HOD, Department of Pathology, Hassan Institute of Medical Sciences, Hassan Email: [email protected]

Abstract Newer hematological parameters such as platelet indices, especially mean platelet volume (MPV) has been clinically utilised in recent years. In the major cause of unstable coronary syndromes, mainly in atherosclerosis, platelet plays an important role. MPV is an indicator of platelet activation and its measurement might be useful in the diagnosis of disorders of thrombopoeisis. In acute myocardial infarction and acute coronary syndromes, MPV values reported to be increased. The present prospective study was conducted in Department of Pathology, Hassan Institute of Medical Sciences, Hassan. Objective of this study was to determine the relationship between mean platelet volume and platelet count and also to know the normal range for mean platelet volume in healthy adult population. After detailed analysis, our study results revealed that the platelet count and mean platelet volume were found to be inversely proportional to each other. The patients having higher MPV values can be evaluated carefully, especially for disorders of thrombopoeisis, occlusive arterial diseases and atherosclerosis. Keywords: Mean Platelet Volume, Platelet Count, Healthy Population, Disorders of thrombopoeisis.

*Address for Correspondence: Dr. Udasimath. Shivakumarswamy, Associate Professor, Department of Pathology, Hassan Institute of Medical Sciences (HIMS), Hassan –573 201, Karnataka. INDIA. E-mail: [email protected] Received Date: 06/01/2019 Revised Date: 12/03/2019 Accepted Date: 07/05/2019 DOI: https://doi.org/10.26611/10512311

normal individuals.4 MPV reflects the platelet activity. It Access this article online is a reliable indicator of platelet activation and synthesis. It Quick Response Code: is increased in conditions such as acute myocardial Website: infarction and acute coronary syndromes.5 The present

www.medpulse.in study is conducted to determine the relationship between mean platelet volume and platelet count, and also to assess the normal range for mean platelet volume in received sample of healthy individuals to our hospital. Accessed Date:

17 December 2019 MATERIALS AND METHODS This prospective study was conducted in the Department of Pathology, Hassan Institute of Medical Sciences, INTRODUCTION Hassan, Karnataka, India. The study was carried out Platelets are one of the formed elements of blood. They between July 2018 to March 2019 of 09 months duration. play an important role in formation of primary hemostatic Total number of samples subjected for the study was 1500. plug in bleeding diathesis. Both quantitative and The platelet count and mean platelet volume was measured qualitative alterations in platelets may lead to bleeding in these samples by Cell Dyn Ruby from Abott company. disorders.1 Normal platelet count ranges from 150 to 450 Preliminary data of age and relevant history for health x109/l. The mean platelet volume in health ranges from 7.7 status were taken from the requisition forms sent along to 11.2 fl.2 Newer hematological parameters especially with the samples in the laboratory. MPV has been utilised in recent years by clinicians.3 The size of the platelets and platelet volume varies in presumed

How to cite this article: Udasimath Shivakumarswamy, Purushotham R, Nagesha K R. Relationship between mean platelet volume and platelet count: A prospective study in healthy adult population. MedPulse International Journal of Pathology. December 2019; 12(3): 171-175. https://www.medpulse.in/Pathology/ MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 12, Issue 3, December 2019 pp 171-175

Inclusion Criteria: The study group comprised of blood hematological disease, autoimmune disease and other samples of normal healthy adults between the age group of chronic disorders were excluded from the study. 19 to 59 years of both sexes. Using the collected data, correlation between the platelet Exclusion criteria: Blood samples from subjects with count and mean platelet volume was done. Correlation various disorders like hypertension, diabetes mellitus, with age, sex was also conducted along with normal range atherosclerosis, thyroid disease, dyslipidaemia, for mean platelet volume in the studied samples.

RESULTS Total number of samples of adult healthy subjected for this study was 1500. Among this, 849 belonged to males and 651 belonged to females with male to female ration of 1.3: 1 (Table 1). The mean age of this study was 36 years.

Table 1: Male and female shows the distribution pattern Total number of samples Males Females 1500 849 651 Majority of them were found to be within the age group of 19-59 years. The range of platelet count in the normal subjects was 26 to 490 x 103/ul with a mean of 194 x 103/ul. The range for platelet volume was 6 to 10.9 fl with a mean of 7.4fl. The mean of platelet count and volume are given in Table 2 and 3.

Table 2: Mean Platelet Parameters in Males Age (In years) Number Platelet count(103/ ul) MPV (fl) 18-25 93 178.463 7.201 26-30 99 208.812 7.274 31-35 133 214.736 7.402 36-40 161 206.315 7.395 41-45 153 193.087 7.438 46-50 78 188.734 7.469 51-55 98 192.425 7.687 56-60 34 146.873 7.102

Table 3: Mean Platelet Parameters in Females Age (In years) Number Platelet count(103/ ul) MPV (fl) 18-25 48 214.257 7.131 26-30 111 194.615 7.435 31-35 93 187.423 7.413 36-40 81 179.221 7.473 41-45 93 202.127 7.593 46-50 87 191.215 7.614 51-55 111 181.316 7.248 56-60 27 185.359 7.584

Figure 1 Figure 2 Figure 3 Legend Figure 1: Bar diagram showing Platelet Count distribution in Males and Females; Figure 2: Bar diagram showing Mean Platelet Volume (MPV) in Males and Females; Figure 3: Diagram showing MPV and Platelet count Correlation

MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 12, Issue 3, December 2019 Page 172 Udasimath Shivakumarswamy, Purushotham R, Nagesha K R

A non random relation was carried out between platelet thrombopoeisis and platelet synthesis can be aided by count and size of platelet. Younger women had higher measurement of platelet volume. Hence, availability the platelet count when compared to men of the same age. potential of platelet parameters can be effectively utilized With advancing age, platelet count decreased. When by the clinicians.11 compared to females of the same age platelet count values Newer hematological parameters such as platelet indices were significantly lower in males (Figure 1). especially MPV, has been explored in recent years and can Compared to males, MPV was found to be higher in be utilized by treating physicians.12 In presumed normal females. With advancing age, MPV showed a decreasing individuals, the size of the platelets varies. Platelet volume trend in males. In our study, males in the age group of 55 differs with the count or number. It also varies with the to 60 showed a significantly lower MPV. The mean type of anticoagulant used, type of blood collection. platelet volume was found to be inversely proportional to Values can also vary with the time of sample collection, the platelet count. Finally, we observed that with duration between collection and analysis, and the method progressively higher platelet count, a progressive but non- used to measure cell size.4 Size of platelet also differs linear decline in MPV was observed. (Figure 2). depending upon the underlying conditions. For examples, The mean platelet count was found to be 194 x103/ul. The in immune thrombocytopenic purpura cases, they are mean of MPV was found to be 7.4fl. Hence, our study larger and in acute leukaemia cases they are smaller. By findings also revealed that the platelet count and mean various studies and research results revealed that platelet platelet volume were found to be inversely proportional to count varied inversely with platelet volume.3,10,13 Mean each other (Figure 3). platelet volume (MPV) is a reliable indicator of platelet activation and synthesis. Increased thrombogenic DISCUSSION tendencies along with increase in cardiovascular risks are Platelets are one of the components of blood and are associated with increased MPV. In acute coronary derived from bone marrow megakaryocytes. Platelets play syndromes and acute myocardial infarction leading to high an important role in formation of primary hemostatic plug mortality cases have shown increase in MPV values.5,13 in bleeding diathesis. Quantitative and qualitative The major sources of error for reliable measurements of abnormalities of platelets lead to bleeding in the form of platelet size and volume are as follows. When sample of pethichae and purpura in skin, mucosa and visceral blood was collected in EDTA and the other one was when surfaces. Normal platelet count ranges from 150 to 450 blood sample is allowed to cool from 37o C to room x103/ul. Platelets appear as small, anucleate cell fragments, temperature. Both these parameters showed an increase in pink to purple colored bodies with irregular borders. They MPV.11 Various studies results have shown that the platelet measure 1-3 micron in Giemsa stained peripheral blood count varies with the age and sex of the patient. Platelet smears. The mean platelet volume (MPV) in health ranges count is higher in women when compared to men of same from 7.7 to 11.2 fl.2 Giles et al was one of the first persons age. With different ethnic populations also, significant to record mean platelet volume who conducted his study differences was noted in platelet count too.12 Hence, the on 5000 blood samples.3 The platelet count in normal present study was carried out to determine the relationship individuals and population varies considerably. between mean platelet volume and platelet count. We also Relationship between platelet size and number which was assessed the normal range for mean platelet volume in first postulated in 1974.3,6 Circulating platelets vary collected samples of 1500 healthy individuals. considerably both in size and functional activity. Larger By detailed history, nothing significant past medical platelets are younger, reactive and produce more history, reliable clinical details and investigations, normal thrombogenic substances when compared to smaller samples were subjected for the study. Giles et al and Rehan platelets.7 Automated blood cell counters provide us a Qayyum et al, showed that around 90- 95% of adults who platelet count and indices with respect to the size of the had been admitted to the hospital, showed a MPV which platelet. A low platelet volume is associated with a higher varied from 7 to 10.5fl3,14 Larger sized platelets are platelet count. The platelet count and volume are inversely produced from activated megakaryocytes in the bone proportional to each other8 Fluctuations arise only when marrow. These large platelets are likely to be more reactive there is increase or decrease in the platelet size and also than their normal sized counterparts.15 Platelet volume is with respect to the sex of the blood sample.9 In calculated by automated machine and the average of all the atherosclerosis, platelets have an important role. Activated platelet assessed will give MPV10,15 Increase in the platelets are one of the major causes for unstable coronary production of newer platelets will increase MPV. These syndromes.10 Assessing the particle size automated newer platelets are immature and appear larger in size12,16 instruments measure platelet volume. Diagnosis and Therefore, an increase in MPV can be a useful and reliable management of various conditions involving marker of platelet activation. Hence, cardiovascular risk

Copyright © 2019, Medpulse Publishing Corporation, MedPulse International Journal of Pathology, Volume 12, Issue 3 December 2019 MedPulse International Journal of Pathology, Print ISSN: 2550-7605, Online ISSN: 2636-4697, Volume 12, Issue 3, December 2019 pp 171-175 can be evaluated by reading of MPV values.9,16 Based on 2. Briggs C, Harrison P, Machin SJ. Continuing our current study reports 95% of the healthy individual’s developments with the automated platelet count. Int J Lab samples had a MPV of 7- 7.5 fl. After correlation analysis, Hematol. 2007 Apr;29:77-91. 3. C. Giles. The platelet count and mean platelet volume. we also noted that there was a significant inverse British journal of hematology, 1981;48:31-37. relationship between the platelet count and volume. The 4. S.R. Jackson, J.M. Carter. Platelet volume: laboratory same findings were well documented by various measurements and clinical application. British authors.14,17 Platelet count also varies with age. After Reviews1993;7:104-113. analyzing, our findings revealed that males in the age 5. Leif Jansson. Relationship of mean platelet volume to group of 18-25 had a lower platelet count as compared to platelet count in morphologic evaluation of thrombopoeisis. Scand j Hematol, 1985;35:363-366. females of the same age. Male blood samples showed a 6. Xavier Troussard, SylvianeVol, Edourd Cornet, drop in the count with progressing age. But in contrast the ValerieBardet, Jean Paul Couaillac, Chantal Fossat, et al. platelet count remained on the higher side with increasing Full blood count normal reference values for adults in age in female blood samples.9, 14 In our study, we observed France. J clin pathology 2013;0:1-4. that an inverse relation was noticed between platelet count 7. C. Briggs. Quality counts: parameters in blood cell and platelet volume in both sexes. In male blood samples, counting. International journal of laboratory hematology 2009;31:277-297. the MPV was at its peak around 51-55yrs. Readings were 8. Juan Zhang, Mingyong Li, Yuan He. Large population marginally higher in men when compared with female of study for age and gender related variations of platelet same age. In females, MPV reading also increased with indices in southwest China healthy adults. Hematology progressively age.3,9,12 When platelet abnormalities exist, and transfusion international journal 2015; (4):00023. stability of these parameters in the normal population helps 9. Barbera J. Bain. Platelet count and platelet size in males to distinguish platelet related disorders.18 Increased MPV and females. Scand Journal of Hematol, 1985;35:77-79. 10. J.David Bessman, Larry J. Williams, P.Ridgway Gilmer. is also noted in patients with thrombocytopenia resulting The inverse relation of platelet size and count in normal 18,19 from peripheral destruction. This is in contrast to those subjects, and an artifact of other particles. American patients whose thrombocytopenia is hypoproliferative in journal of clinical pathologists. 1981Sep;76(3). nature where the MPV is decreased.20 Patients with 11. GergoryA.Threatte, Clara Adrados, Shirley Ebbe and thrombocytopenia due to increased peripheral destruction George Brecher. Mean platelet volume: The need for a have a low platelet count. But in these cases, a greater reference method brief scientific reports, 1983;81(6). 12. Ginevra Biino, Iolanda Santimone, Cosetta Minelli, percentage of them are younger, larger and have a better Rossella Sorice, Bruno Frongia, Michela Traglia, et al. 19, 21 functional capacity After detailed analysis, our study Age and sex related variations in platelet count in Italy: A findings correlated with Leif Jansson study5, Barbera J. proposal of reference ranges based on 40987 subjects data. 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Conflict of Interest: None Declared

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