Acta Medica Mediterranea, 2018, 34: 1665

THE EVALUATION OF MEAN PLATELET VOLUME OF CHILDREN WITH HYPERTRO- PHY

MEHMET TOLGA KÖLE¹, HÜSEYIN DAй, OKAN DIKKER², VEFIK ARICA¹, YUSUF ÖZTÜRKCܳ, İBRAHIM KANDEMIR4, MURAT DOĞAN¹, HABIP GEDIK5 1Department of Pediatrics, Health Sciences University, Okmeydanı Training and Research Hospital, İstanbul, Turkey - 2Department of Medical Biochemistry, Health Sciences University, Okmeydanı Training and Research Hospital, İstanbul, Turkey - 3Department of Otolaryngology-Head and Surgery, Health Sciences University, Okmeydanı Training and Research Hospital, İstanbul, Turkey - 4Department of Pediatrics, Istanbul University Istanbul Medical Faculty Hospital, Istanbul, Turkey - 5Department of Infectious Diseases and Clinical Microbiology, Health Sciences University, Bakirköy Dr. Sadi Konuk Training and Research Hospital, İstanbul, Turkey

ABSTRACT

Objective: We aimed to compare the platelet distribution width (PDW) and platelet parameters (PLT), particularly MPV values of children who were diagnosed with adenoid hypertrophy at the pediatric clinic with those of healthy children to investi- gate a relationship between adenoid hypertrophy and MPV values. Material and method: This prospective, cross-sectional study was conducted at the department of pediatrics, Health Sciences University, Ministry of Health Okmeydanı Training and Research Hospital between January 2012 and December 2014. The PLT and PDW values as well as MPV of children who were diagnosed with adenoid hypertrophy were compared with those of healthy children. Results: In this study, 120 children with adenoid hypertrophy and 120 healthy children were evaluated. The age range of participants was between 3 years and 16 years, and the mean age was 9.13±2.94 years. The mean MPV value in children with adenoid hypertrophy (10.88 ± 1.15 fL) was statistically significantly higher than that in the control group (9.84 ± 1.04 fL). While the mean platelet distribution width value in the adenoid hypertrophy group was statistically significantly higher than that of the control group, there was no statistically significant difference between the mean platelet counts of both groups. Conclusion: MPV, PLT, and PDW values did not differ significantly in children with adenoid hypertrophy compared to healthy children. MPV values were determined significantly higher in children with adenoid hypertrophy when compared with healthy children. Children with adenoid hypertrophy should be followed up in terms of cardiovascular diseases on the long view.

Keywords: , Mean Platelet Volume, Child.

DOI: 10.19193/0393-6384_2018_6_255

Received January 30, 2018; Accepted March 20, 2018

Introduction cases who have a viral etiology with symptoms (characterized by fever, , sore throat, rhinor- Upper infection is a non-spe- rhea, and general malady) recover within three to cific term used to describe an acute infection five days with a mainly symptomatic treatment. involving nose, , and lar- A source of infections of the upper airway, the ynx. The and diseases are inflammatory process, result of the interaction very common in preschooler and young children between microbes and the immune response such as who are susceptible to upper respiratory tract infec- recently demonstrated(2). tions, especially those who attend day care centers. The most common symptoms are fever, cough, They often cause bacterial complications, especial- sore throat, related to , and otitis ly acute (1). media with effusion as a recent study by Martines The inflammatory process takes in the et al and other study confirmed the literature data, it oropharynx and/or the tonsil and the majority of was shown how children with a history of upper 1666 Mehmet Tolga Köle, Hüseyin Dağ et Al respiratory tract infections are more likely to devel- In the present study, we aimed to compare the op this form of otitis(3, 4). Tonsils and adenoid tissues platelet distribution width (PDW) and platelet para- are the most important defense systems against meters (PLT), particularly MPV values of children microorganisms. Adenotonsillar hypertrophy is one who were diagnosed with adenoid hypertrophy at of the childhood common diseases(5). the pediatric clinic with those of healthy children to Recurrent infections lead to hypertrophic ade- investigate a relationship between adenoid hyper- noid tissue and a source of chronic infections, or trophy and MPV values. may cause obstructive symptoms. Adenoid hyper- trophy usually manifests itself with symptoms sec- Material and method ondary to nasal . The most com- mon symptoms are difficulty in nasal and oral This prospective, cross-sectional study was , hyponasal speech, , sleep-related conducted at the department of pediatrics, Health respiratory disorders, sinusitis, and otitis(6). In Sciences University, Ministry of Health Okmeydanı chronic cases, upper disorders Training and Research Hospital between January secondary to craniofacial developmental disorders, 2012 and December 2014. The PLT and PDW val- , and cor pulmonale can be ues as well as MPV of children who were diag- observed as well(7). nosed with adenoid hypertrophy were compared Platelets basically pay a role in thrombosis and with those of healthy children. This study was hemostasis. However, recent studies showed that approved by Ministry of Health Okmeydanı platelets play a great role in infection and inflam- Training and Research Hospital’s local Ethics mation(8). It was shown that chemokines secreted Committee on 17.02.2015 with number 275. from activated platelet membranes have important Children who had an acute infection, hemato- roles in immune response. These secreted logic diseases, immunodeficiency, moderate or chemokines were shown to act in the first immune severe malnutrition, congenital or genetic diseases, response as acute phase reactants. They work as recurring and/or chronic pulmonary disease, or neutrophils, granulocytes, and monocytes and have received steroid treatment were not included in the even direct antimicrobial effects(9, 10). When platelet study. Children, who presented with complaints of s are activated, and secreted inflammatory factors, , snoring, hyponasal speech, oral such as chemokines and cytokines, their sizes are respiration, ‘adenoid face’ with impaired dental and increased. In other words, MPV is a marker show- craniofacial development, and infections such as ing that platelet is activated(11). MPV is being stud- recurring sinusitis, otitis or , and respiratory ied as a part of routine whole blood count parame- problems that become more prominent during ters in whole blood count analyzers(12, 13). sleep, were referred with the pre-diagnosis of ade- There are studies reporting that the mean noid hypertrophy. Snoring, recurrent infections, platelet volume has been high in patients with ade- nasal congestion, and decreased hearing, which noid hypertrophy, and it has been decreased after were the most common symptoms in cases with (14). By affecting on megakaryocytes, preliminary diagnosis of adenoid hypertrophy, were interleukin-3 and interleukin-6 lead to the forma- evaluated. Decreased hearing was confirmed by the tion of larger platelets. Increased MPV is also otolaryngologist. Adenoid hypertrophy diagnosis in shown in obesity(15). It has been reported that inter- patients referred to the ear-nose-throat outpatient leukin-6 level increases in obese patients, and clinic was confirmed by nasopharyngoscopy. The increased interleukin-6 in obesity could result in an frequency and relationship between adenoid hyper- increased MPV(14). trophy and the complaints were evaluated by calcu- MPV is a marker of thrombocyte activation lating the rate and frequency of the complaints in that is associated with cardiovascular complica- both, all cases and the patient group only. tions, and large platelets that mean more active Laboratory parameters were compared between thrombocytes and a tendency to thrombosis(17, 18). subgroups formed between the groups with and Hypertension, hypercholesterolemia, diabetes, without adenoid hypertrophy, and based on the acute myocardial infarction, stroke, upper airway complaints. obstruction accompanied by septal deviation and In statistical analysis, descriptive statistical severe sleep syndrome are causes leading to methods (mean, standard deviation, median, fre- MPV increase(15, 19, 20). quency, and ratio, minimum, maximum) were used. Evaluation of mean platelet volume of children with adenoid hypertrophy 1667

Student t test was used in comparison of quantita- MPV(fL) PDW(fL) PLT(103/µL) tive data between two groups with normally distrib- uted variables. Mann-Whitney U test was used in Mean±SD Mean±SD Mean±SD comparison of two groups with abnormally distrib- MALE 10.83±1.03 16.52±0.55 325628.57±90689.50 uted parameters. The level of significance was GENDER FEMALE 10.94±1.30 16.314±0.72 308420±71407±17 accepted as p < 0.05. p: 0.585 p: 0.085 p: 0.266

Results PRESENT 10.82±1.06 16.35±0.55 329759.26±88297 SNORING ABSENT 10.92±1.22 16.50±0.69 309212.12±78469.11

In this study, 120 children with adenoid p: 0.623 p: 0.192 p: 0.180 hypertrophy and 120 healthy children were evaluat- PRESENT 10.83±1.23 16.45±0.72 314269.23±77044.71 ed. The age range of participants was between 3 RECURRENT years and 16 years, and the mean age was INFECTION ABSENT 10.90±1.10 16.42±0.57 321661.76±88236.73 9.13±2.94 years. In the study, symptoms of children p: 0.721 p: 0.761 p: 0.632 with adenoid hypertrophy were snoring in 45%, PRESENT 10.92±0.98 16.51±0.64 322339.29±88683.76 recurrent infections in 43.3%, nasal congestion in NASAL CONGE- ABSENT 10.84±1.29 16.36±0.62 315062.50±78864±74 46.7%, and decreased hearing in 22.5%. The mean STION MPV (10.88 ± 1.15 fL) and PDW values p: 0.721 p: 0.182 p: 0.635

(16.43±0.63 fL) of the patients group were statisti- PRESENT 10.64±1.11 16.54±0.69 305037.04±108941.23 cally significantly higher than those of healthy con- DECREASED ABSENT 10.95±1.16 16.40±0.62 322354.84±74537.37 trol group (9.84 ± 1.04 fL; 12.21±2.19; p=0.001; p: HEARING 0.001), respectively. There was no statistically sig- p: 0.221 p: 0.328 p: 0.344 nificant difference in platelet counts between the Table 2: The comparison of laboratory values by com- groups (p=0.147; Table 1). plaints in the patients group. Total Patient Control (n=240) (n=120) (n=120) p Mean±SD Mean±SD Mean±SD Although those values were lower than those of both control group and adenoid hypertrophy PLT (103/µL) 310854.17±81058.32 318458±83312.91 303250±78348.31 0.147 cases group, high MPV values supported our find- MPV(fL) 10.36±1.21 10.88±1.15 9.84±1.04 0.001** ings. That was likely to be related to older mean PDW (fL) 14.32±2.66 16.43±0.63 12.21±2.19 0.001** age in our study (9.13 years versus 4.4 years). Table 1: The comparison of laboratory parameters In their study, there was no significant differ- between children with adenoid hypertrophy and healthy ence in PLT and PDW values between two groups, children. and MPV values recovered to normal after ade- noidectomy. In our study, there was no statistical There was no statistically significant differ- difference in PLT values between two groups, but ence between the MPV, PDW, and PLT values of PDW values were significantly higher in children the cases by their gender and conditions of snoring, with adenoid hypertrophy than those of the con- recurrent infection, nasal congestion and decreased trols. hearing (p> 0.05; Table 2). Onder et al. evaluated MPV, PLT, and PDW levels 3 months before and after adenoidectomy in Discussion 61 cases(17). They reported no significant postopera- tive difference in these parameters. Their study In our study, the mean MPV value of children included a younger cohort and fewer participants with adenoid hypertrophy was statistically higher than when compared with our study, and the mean age that of the control group. Our findings indicated that was 7.12 years. Contrary to our study, MPV values MPV values might be used as a biomarker alone for were concluded not be associated with adenoid adenoid hypertrophy. Kucur et al. reported that MPV hypertrophy and upper airway obstruction, and values of adenoid hypertrophy cases (8.25 ± 1.1 / 7.5 more studies should be performed to enlighten thus ± 0.9 fL) were significantly higher than those of issue. healthy children in their study including 104 cases Tuncel et al. reported that there was no statisti- with adenoid hypertrophy and 100 normal cases cal difference in MPV values between 100 children whose the mean age was 4.4 years(14). with and 49 normal children with the mean 1668 Mehmet Tolga Köle, Hüseyin Dağ et Al age of 8.2 years, and no significant difference was including snoring, recurrent infections, nasal con- determined in MPV values between asthma attack gestion, decreased hearing, and gender compared to and during asymptomatic phase in their study(21). healthy children. 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