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 JBM  Vol.6 No.9 , September 2018
Value of Pre- and Post-Treatment Platelet Indices in Patients with Immune Thrombocytopenic Purpura
Abstract: Introduction: Immune thrombocytopenic purpura (ITP) is an acquired disorder characterized by isolated thrombocytopenia. There is no “gold standard” test that can establish the diagnosis of primary ITP. Therefore, the diagnosis is one of exclusion and is based on patient history, physical examination, complete blood count, and blood smear review. Platelet indices are biomarkers of platelet activation, allowing extensive investigations focusing on the diagnostic and prognostic values in various diseases without extra-costs. Mean platelet volume (MPV), platelet distribution width (PDW) and plateletcrit (PCT) were investigated aiming at evaluating the correlation between pre- and post-treatment values in ITP patients. The sensitivity and specificity of platelet indices for assessment of their predictive value for treatment response were also evaluated. Methods: Fifty newly diagnosed primary ITP patients were selected from the Hematology Clinics of Ain Shams University Hospitals and classified into pediatric and adult groups. Platelet count, MPV, PDW, PCT have been recorded for all pre and post-treatment CBC samples using Beckman Coulter LH750 analyzer. Results: In pediatrics post-treatment MPV and PDW were significantly decreased while PCT was increased when compared to their values at the time of presentation (P < 0.01). The same results were obtained in adult patients, except for PDW which did not attain any significance. A significant correlation was found between pre-treatment values of these platelet indices and treatment response in pediatrics, while no significance was found between pre-treatment PDW and treatment response in adults. Conclusion: Increased pre-treatment MPV and PDW, and decreased PCT can provide diagnostic and predictive value for treatment response in ITP patients.
Cite this paper: Omar, I. , Abuelela, S. and Emam, N. (2018) Value of Pre- and Post-Treatment Platelet Indices in Patients with Immune Thrombocytopenic Purpura. Journal of Biosciences and Medicines, 6, 11-24. doi: 10.4236/jbm.2018.69002.
References

[1]   Rodeghiero, F., Stasi, R., Gernsheimer, T., Michel, M., Provan, D., Arnold, D.M., Bussel, J.B., Cines, D.B., Chong, B.H., Cooper, N., Godeau, B., Lechner, K., Mazzucconi, M.G., McMillan, R., Sanz, M.A., Imbach, P., Blanchette, V., Kühne, T., Ruggeri, M. and George (2009) Standardization of Terminology, Definitions and Outcome Criteria in Immune Thrombocytopenic Purpura of Adults and Children: Report from an International Working Group. Blood, 113, 2386-2393.
https://doi.org/10.1182/blood-2008-07-162503

[2]   Blanchette, V. and Bolton-Maggs, P. (2008) Childhood Immune Thrombocytopenic Purpura: Diagnosis and Management. Pediatric Clinics of North America, 55, 393-420.
https://doi.org/10.1016/j.pcl.2008.01.009

[3]   Gernsheimer, T. (2008) Epidemiology and Pathophysiology of Immune Thrombocytopenic Purpura. European Journal of Haematology, 80, 3-8.
https://doi.org/10.1111/j.1600-0609.2007.00998.x

[4]   Cines, D.B., Bussel, J.B., Liebman, H.A. and LuningPrak, E.T. (2009) The ITP Syndrome: Pathogenic and Clinical Diversity. Blood, 113, 6511-6521.
https://doi.org/10.1182/blood-2009-01-129155

[5]   Neunert, C., Lim, W., Crowther, M., Cohen, A., Solberg Jr., L. and Crowther, M.A. (2011) The American Society of Hematology 2011 Evidence-Based Practice Guideline for Immune Thrombo-cytopenia. Blood, 117, 4190-4207.
https://doi.org/10.1182/blood-2010-08-302984

[6]   Vianelli, N., Valdre, L. and Fiacchini, M. (2001) Long-Term Follow-Up of Idiopathic Thrombocytopenic Purpura in 310 Patients. Haematologica, 86, 504-509.

[7]   Gao, Y., Li, Y., Yu, X., Guo, S., Ji, X., Sun, T., Lan, C., Lavergne, V. and Ghannoum, L. (2014) The Impact of Various Platelet Indices as Prognostic Markers of Septic Shock. PloS ONE, 9, e103761.
https://doi.org/10.1371/journal.pone.0103761

[8]   Rajantie, J., Javela, K., Joutsi-Korhonen, L. and Kekomaki, R. (2004) Chronic Thrombocytopenia of Childhood: Use of Non-Invasive Methods in Clinical Evaluation. European Journal of Haematology, 72, 268-272.
https://doi.org/10.1111/j.1600-0609.2004.00215.x

[9]   Wiwanitkit, V. (2004) Plateletcrit, Mean Platelet Volume, Platelet Distribution Width: Its Expected Values and Correlation with Parallel Red Blood Cell Parameters. Clinical and Applied Thrombosis/Hemostasis, 10, 175-178.
https://doi.org/10.1177/107602960401000208

[10]   Vagdatli, E., Gounari, E., Lazaridou, E., Katsibourlia, E., Tsikopoulou, F. and Labrianou, I. (2010) Platelet Distribution Width: A Simple, Practical and Specific Marker of Activation of Coagulation. Hippokratia, 14, 28-32.

[11]   Akpinar, I., Sayin, M.R., Gursoy, Y.C., Aktop, Z., Karabag, T., Kucuk, E., Sen, N., Aydin, M., Kiran, S., Buyukuysal, M.C. and Haznedaroglu, I.C. (2014) Plateletcrit and Red Cell Distribution Width Are Independent Predictors of the Slow Coronary Flow Phenomenon. Journal of Cardiology, 63, 112-118.
https://doi.org/10.1016/j.jjcc.2013.07.010

[12]   Vinholt, P.J., Hvas, A.M. and Nybo, M. (2014) An Overview of Platelet Indices and Methods for Evaluating Platelet Function in Thrombocytopenic Patients. European Journal of Haematology, 92, 367-376.
https://doi.org/10.1111/ejh.12262

[13]   Chandra, H., Chandra, S., Rawat, A. and Verma, S.K. (2010) Role of Mean Platelet Volume as Discriminating Guide for Bone Marrow Disease in Patients with Thrombocytopenia. International Journal of Laboratory Hematology, 32, 498-505.
https://doi.org/10.1111/j.1751-553X.2009.01212.x

[14]   Dastjerdi, M.S., Emami, T., Najafian, A. and Amini, M. (2006) Mean Platelet Volume Measurement, EDTA or Citrate? Hematology, 11, 317-319.
https://doi.org/10.1080/10245330600954163

[15]   Segal, J.B. and Powe, N.R. (2006) Prevalence of Immune Thrombocytopenia: Analyses of Administrative Data. Journal of Thrombosis and Haemostasis, 4, 2377-2383.
https://doi.org/10.1111/j.1538-7836.2006.02147.x

[16]   Libert, C., Dejager, L. and Pinheiro, I. (2010) The X Chromosome in Immune Functions: When a Chromosome Makes the Difference. Nature Reviews Immunology, 10, 594-604.
https://doi.org/10.1038/nri2815

[17]   Malpass, J., Lavigne, J.L., Pope, J. and Oesterheld, J. (2015) Investigation of Mean Platelet Volume as a Predictor of Acute versus Chronic Immune Thrombocytopenic Purpura in Children: An Exploratory Analysis. Clinical Nursing Studies, 3, 23.

[18]   Arceci, R.J., Hann, I.M., Smith, O.P. and Hoffbrand, A.V. (2006) Pediatric Hematology. Blackwell Pub., Malden.
https://doi.org/10.1002/9780470987001

[19]   Kühne, T., Buchanan, G.R., Zimmerman, S., Michaels, L.A., Kohan, R., Berchtold, W. and Imbach, P. (2003) A Prospective Comparative Study of 2540 Infants and Children with Newly Diagnosed Idiopathic Thrombocytopenic Purpura (ITP) from the Intercontinental Childhood ITP Study Group. Journal of Pediatrics, 143, 605-608.
https://doi.org/10.1067/S0022-3476(03)00535-3

[20]   Shirahata, A., Fujisawa, K. and Ishii, E. (2009) A Nationwide Survey of Newly Diagnosed Childhood Idiopathic Thrombocytopenic Purpura in Japan. Journal of Pediatric Hematology/Oncology, 31, 27-32.
https://doi.org/10.1097/MPH.0b013e318190d44e

[21]   Neylon, A.J., Saunders, P.W., Howard, M.R., Proctor, S.J. and Taylor, P.R. (2003) Clinically Significant Newly Presenting Autoimmune Throm-bocytopenic Purpura in Adults: A Prospective Study of a Population-Based Cohort of 245 Patients. British Journal of Haematology, 122, 966-974.
https://doi.org/10.1046/j.1365-2141.2003.04547.x

[22]   George, J.N., Woolf, S.H., Raskob, G.E., Wasser, J.S., Aledort, L.M., Ballem, P.J., Blanchette, V.S., Bussel, J.B., Cines, D.B., Kelton, J.G. and Lichtin, A.E. (1996) Idiopathic Thrombocytopenic Purpura: A Practice Guideline Developed by Explicit Methods for the American Society of Hematology. Blood, 88, 3-40.

[23]   Van der Lelie, J. and Von dem Borne, A.K. (1982) Increased Mean Platelet Volume in Septicaemia. Journal of Clinical Pathology, 36, 693-696.
https://doi.org/10.1136/jcp.36.6.693

[24]   Korkmaz, S., Uslu, A.U., Aydin, B., Dogan, O. and Sencan, M. (2013) Pre-Treatment and Post-Treatment Changes in Platelet Indices in Patients with Immune Thrombocy-topenia. Saudi Medical Journal, 34, 591-596.

[25]   Adly, A.A. (2014) Pathophysiology of Immune Thrombocytopenic Purpura: A Bird’s-Eye View. Egyptian Journal of Pediatric Allergy and Immunology, 12, 49-61.

[26]   Kaito, K., Otsubo, H., Usui, N., Yoshida, M., Tanno, J., Kurihara, E., Matsumoto, K., Hirata, R., Domitsu, K. and Kobayashi, M. (2005) Platelet Size Deviation Width, Platelet Large Cell Ratio, and Mean Platelet Volume Have Sufficient Sensitivity and Specificity in the Diagnosis of Immune Thrombocytopenia. British Journal of Haematology, 128, 698-702.
https://doi.org/10.1111/j.1365-2141.2004.05357.x

[27]   Ntaios, G., Papadopoulos, A., Chatzinikolaou, A., Saouli, Z., Karalazou, P., Kaiafa, G., Girtovitis, F., Kontoninas, Z., Savopoulos, C., Hatzitolios, A. and Alexiou-Daniel, S. (2008) Increased Values of Mean Platelet Volume and Platelet Size Deviation Width May Provide a Safe Positive Diagnosis of Idiopathic Thrombocytopenic Purpura. Acta Haematologica, 119, 173-177.
https://doi.org/10.1159/000135658

[28]   Budak, Y.U., Polat, M. and Huysal, K. (2016) The Use of Platelet Indices, Plateletcrit, Mean Platelet Volume and Platelet Distribution Width in Emergency Non-Traumatic Abdominal Surgery: A Systematic Review. Biochemiamedica, 26, 178-193.
https://doi.org/10.11613/BM.2016.020

[29]   Ahmed, S., Siddiqui, A.K., Shahid, R.K., Kimpo, M., Sison, C.P. and Hoffman, M.A. (2004) Prognostic Variables in Newly Diagnosed Childhood Immune Thrombocytopenia. American Journal of Hematology, 77, 358-362.
https://doi.org/10.1002/ajh.20205

[30]   Donato, H., Picón, A., Martinez, M., Rapetti, M.C., Rosso, A., Gomez, S., Rossi, N., Bacciedoni, V., Schvartzman, G., Riccheri, C. and Costa, A. (2009) Demographic Data, Natural History, and Prognostic Factors of Idiopathic Thrombocytopenic Purpura in Children: A Multicentered Study from Argentina. Pediatric Blood & Cancer, 52, 491-496.
https://doi.org/10.1002/pbc.21872

[31]   Zhang, Z., Xu, X., Ni, H. and Deng, H. (2014) Platelet Indices Are Novel Predictors of Hospital Mortality in Intensive Care Unit Patients. Journal of Critical Care, 29, 885.
https://doi.org/10.1016/j.jcrc.2013.09.002

[32]   Negash, M. and Tsegaye, A. (2016) 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 Hematology, 16, 18.
https://doi.org/10.1186/s12878-016-0057-5

[33]   Seth, T. (2011) Current Management of Idiopathic Thrombocytopenic. Recent Advances in Hematology, 3, 238.
https://doi.org/10.5005/jp/books/11240_20

[34]   Pang, S.J. and Lazarus, A.H. (2010) Mechanisms of Platelet Recovery in ITP Associated with Therapy. Annals of Hematology, 89, 31-35.
https://doi.org/10.1007/s00277-010-0916-2

[35]   Bhoria, P., Sharma, S., Varma, N., Malhotra, P., Varma, S. and Luthra-Guptasarma, M. (2015) Effect of Steroids on the Activation Status of Platelets in Patients with Immune Thrombocytopenia (ITP). Platelets, 26, 119-126.
https://doi.org/10.3109/09537104.2014.888546

[36]   Liu, W.J., Bai, J., Guo, Q.L., Huang, Z., Yang, H. and Bai, Y.Q. (2016) Role of Platelet Function and Platelet Membrane Glycoproteins in Children with Primary Immune Thrombocytopenia. Molecular Medicine Reports, 14, 2052-2060.
https://doi.org/10.3892/mmr.2016.5504

[37]   Fan, L. and Wei, W. (2014) Platelet Parameters in Children with Idiopathic Thrombocytopenic Purpura Clinical Application Analysis. Clinical and Experimental Medicine, 13, 124-126.

[38]   Kim, J.T., Lee, K.W., Kim, S.N. and Kim, M.K. (2002) Changes in Mean Platelet Volume and Platelet Distribution Width after Therapy in Childhood Idiopathic Thrombocytopenic Purpura. Korean Journal of Pediatrics, 45, 505-511.

[39]   Noris, P., Klersy, C., Gresele, P., Giona, F., Giordano, P., Minuz, P., Loffredo, G., Pecci, A., Melazzini, F., Civaschi, E. and Mezzasoma, A. (2013) Platelet Size for Distinguishing between Inherited Thrombocytopenias and Immune Thrombocytopenia: A Multicentric, Real Life Study. British Journal of Haematology, 162, 112-119.
https://doi.org/10.1111/bjh.12349

 
 
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