MARÍA CONSTANZA LUCIARDI, ROSSANA PÉREZ AGUILAR, HÉCTOR LUCIARDI
Facultad de Bioquímica Química y Farmacia UNT. Facultad de Medicina UNT.
(4000) Tucumán, Argentina E-mail
Recibido 21-MARZO-2019 – ACEPTADO 04-ABRIL-2019.
There are no conflicts of interest to disclose.
Beyond pointing out certain limitations of the study by Varastehravan et al, published in this number of the Revista de la Federación Argentina de Cardiología ; among others, the relatively small size of the sample, that multiple conditions may have affected mean platelet volume (MPV), that the analysis was based on a single measure that may not reflect the state of the patient during extended periods, added to the fact that an MPV cutoff value has not been standardized yet, this parameter is undoubtedly an appealing index for investigation, about which there is currently an increasing interest. See the paper published.
Platelets, also called thrombocytes, are the smallest components in blood. They are extremely reactive cytoplasmic fragments. They play a key role on primary hemostasis, on the development of atherosclerosis and thrombotic events , and promote angiogenesis  and immunity .
Platelets display heterogeneous size, density and reactivity. In comparison to the smaller ones, larger platelets present more granules, are more prone to adherence and addition to collagen, produce a greater thromboxane A2 concentration and express more glycoprotein Ib/IX/V and IIb/IIIa receptors, displaying more thrombogenic potential .
MPV decreases with age and increases when there is more production of platelets. A platelet volume >10 fL indicates large platelets and a volume <6 fL indicates small platelets. A volume ≥8.8 fL presents a sensitivity and specificity acceptable for this differentiation between large and small platelets.
The interaction of platelets with endothelial cells leads to an excessive platelet activation, in turn leading to a shorter mean platelet life, with greater platelet replacement .
Platelet volume indices may estimate directly platelet function, and be easily obtained by modern automated hematological analyzers . MPV is a simple, reproducible method, and an easy way to evaluate platelet function.
Different techniques with different tools may result in variable changes in the estimation of different platelet indices. There are also contradictory results on the anticoagulation effect used, and the time elapsed between blood collection and red blood cell indices measurement, among them MPV. Currently, technical problems limit its clinical usefulness, so some authors wonder if it is an emerging marker or an exaggeration .
MPV is an appealing index to study in different clinical scenarios because it is universally available, to adjust reference intervals in platelet count and to follow as an adjustment factor for this count in epidemiological and clinical practice trials .
MPV is a risk marker of disease and cardiovascular complications, and inflammatory diseases. It could be a very good noninvasive tool to differentiate different causes of thrombocytopenia (platelet levels of less than 150 x 109/L may cause bleeding complications) . Alterations in platelet volume are predictive of thrombotic events.
MPV is a measure of platelet size, reflecting changes at the level of platelet stimulation or in the rate of platelet production , and pathological platelet activation. Platelet size correlates to platelet activity and may be evaluated by platelet indices . Increase in MPV has been observed in smoking, diabetes mellitus, obesity, hypertension and dyslipidemia. MPV assessment may provide significant information on the course and prognosis of a variety of inflammatory diseases , with many potential applications.
Platelet size, measured as mean platelet volume, is a marker of platelet reactivity, where the larger platelets are hemostatically more reactive than platelets with a normal volume.
From what has been presented here, MPV could be considered a useful tool as an independent predictive marker, the investigation of which deserves to be approached in different clinical conditions.
Varastehravan H, Ahmadzade M, Nough H, Naghedi A. Correlación entre el volumen plaquetario medio y la esclerosis de la válvula aórtica. Rev Fed Arg Cardiol 2019; 48 (3): __-__.
Kaplan ZS, Jackson SP. The role of platelets in atherothrombosis. Hematology Am Soc Hematol Educ Program 2011; 2011: 51-61.
Linke B, Schreiber Y, Picard-Willems B, et al. Activated platelets induce an anti-inflammatory response of monocytes / macrophages through cross-regulation of PGE2 and cytokines, Mediators Inflamm 2017; 2017: 1463216.
Stocker TJ, Ishikawa-Ankerhold H, et al. Small but mighty: Platelets as central effectors of host defense. Thromb Haemost 2017; 117 (4): 651-61.
Lipinska A, Ledakowicz-Polak A, Krauza G, et al. Complex calculation or quick glance? Mean platelet volume - new predictive marker for pulmonary embolism. Ther Clin Risk Manag 2018; 14: 2221-28.
Pal R, Bagarhatta R, Gulati S, et al. Mean platelet volume in patients with acute coronary syndromes: a supportive diagnostic predictor. J Clin Diagn Res 2014; 8 (8): MC01-4.
Brummitt DR, Barker HF. The determination of a reference range for new platelet parameters produced by the Bayer ADVIA 120 full blood count analyser. Clin Lab Haematol. 2000; 22 (2): 103-7.
Kaya U, Koza Y, Colak A. Mean platelet volume: is it an emerging marker or an exaggeration?. Braz J Cardiovasc Surg 2019; 34 (1): 237.
Ittermann T, Feig M, Petersmann A, et al. Mean platelet volume is more important tan age for defining reference intervals of platelet counts. PLOS ONE 2019| https://doi.org/10.1371/journal.pone.0213658.
Norrasethada L, Wichan Khumpoo W, Rattarittamrong E, et al. The use of mean platelet volume for distinguishing the causes of thrombocytopenia in adult patients Hematology Reports 2019; 11:7732.
Bancroft AJ, Abel EW, Mclaren M, Belch JJ. Mean platelet volume is a useful parameter: a reproducible routine method using a modified Coulter thrombocytometer. Platelets 2000; 11 (7): 379-87.
Sucu M, Davutoglu V, Sari I, et al. Relationship between platelet indices and aortic valve sclerosis. Clin Appl Thromb Hemost 2010; 16 (5): 563-67.
Korniluk A, Martyna Koper-Lenkiewicz O, Kamińska J, et al Mean Platelet Volume (MPV): New perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm 2017; 2017: 1463216.