Are platelet volume indices of clinical use? A multidisciplinary review

Figures & data

Figure 1. Histogram of platelet size distribution and the definition of platelet size deviation width (PDW), and platelet-large cell ratio (P-LCR). From reference (8) with permission. The distribution width at the level of 20% was defined as PDW, and the percentage of the platelets with a size of more than 12 fL was defined as P-LCR.

Table I. Summary of studies^† evaluating the diagnostic value^‡ of platelet volume indices in thrombocytopenia.

Patient population	Study size (n)	Disorder assessed	MPV cutoff (fl)	PDW cut-off (%)	P-LCR cut-off (%)	PPV (%)	NPV (%)	Sensitivity (%)	Specificity (%)	Reference number
ITP and thrombocytopenia due to decreased production	ITP =28; Decreased production =128	ITP	≥8.3≥9.4					10096	6080	(17)
All types of thrombocytopenia	473	Bone marrow disease	≥10.5<8		77		95			(10)
ITP and AA	ITP =39; AA =40	ITP	>11					87.2	80
			>12					59	95
				>13				92.3	75	(8)
				>15				71.8	95
					>30			91.4	73
ITP and thrombocytopenia due to chemotherapy-induced myelo-suppression	ITP =63; myelo-suppression =71	ITP	>9	>15	>30	10010073	10010089.3	10010090.4	10010070.42	(11)
All types of thrombocytopenia	102	Hyperdestructive thrombocytopenia on bone marrow biopsy	>7.9			94.4	77.1	82.3	92.5	(12)
Inherited macro-thrombocytopenia and ITP	MYH9-related disease =15; BSS =20; ITP =56	Inherited macro-thrombocytopenia	>12.4			83	90	83	89	(18)
All types of thrombocytopenia	699	Biopsy-proven bone marrow disease	≤8.15					67.7	65	(15)
All types of pancytopenia	Megaloblastic pancytopenia = 8; Non-megaloblastic pancytopenia = 180	Megaloblastic pancytopenia	> 7.45					63.6	67.3	(20)

AA: aplastic anemia; BSS: Bernard–Soulier syndrome; ITP: idiopathic thrombocytopenic purpura; MPV: mean platelet volume; NPV: negative predictivevalue; PDW: platelet distribution width; P-LCR: platelet-large cell ratio; PPV: positive predictive value.

† The cut-off values presented from each study are those with optimal diagnostic value after receptor operating characteristics curve analysis.

‡All studies either of retrospective or cross-sectional design.

Figure 2. Possible clinical application of platelet volume indices in the diagnosis and management of abnormal platelet counts. †Many cut-off values are based on small studies and as such should be confirmed with prospective evaluation. ‡In the suitable clinical setting. ITP = idiopathic thrombocytopenic purpura; MPD = myeloproliferative disorder; MPV = mean platelet volume; PDW = platelet distribution width.

Table II. Summary of studies^* evaluating the diagnostic and prognostic value^† of mean platelet volume in cardiovascular disease.

Patient population	Study size	Nature of end-point	Disorder assessed	MPV^‡ cut-off (fl)	PPV (%)	NPV (%)	Sensitivity (%)	Specificity (%)	Reference number
Studies evaluating the diagnostic value of MPV
Acute chest pain	2304	Primary	Acute MI	>9	43	83			(156)
Acute chest pain	282	Primary	ACS	>10.35			78.3	74.6	(80)
		Secondary	Acute MI	>10.65			78.6	77.6
Studies evaluating the prognostic value of MPV
STEMI undergoing primary PCI	388	Secondary	No-reflow phenomenon on post-PCI angiogram	>10.3			61.9	74.3	(87)
STEMI undergoing primary PCI	617	Primary	TIMI flow 2 or 3 in infarct related artery, on baseline angiography	<8.95	46	82	61.2	70	(88)
STEMI undergoing primary PCI	343	Primary	Impaired reperfusion	>9.05			74	73	(89)
Acute pulmonary embolism	192	PrimarySecondary	Death within 30 daysDeath within 7 days	>10.9	1818	9396	3954	8182	(117)
Decompensated heart failure	136	Secondary	Mortality at 6 months	>10.5			82	66	(100)

ACS: acute coronary syndrome; MI: myocardial infarction; MPV: mean platelet volume; NPV: negative predictive value; PCI: percutaneous coronary intervention; PPV: positive predictive value; STEMI: ST elevation myocardial infarction.

*The studies had retrospective or cross-sectional design or were retrospective analysis of MPV values with prospective follow-up of outcome.

†Calculated from receiver operating characteristics curves.

‡Measured at hospital admission.

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