Mean platelet volume: A novel prognostic factor of rotavirus gastroenteritis?

• Mean platelet volume
• rotavirus gastroenteritis
• prognostic factor

To the editor,

We read with great interest the article ‘Decreased mean platelet volume in children with acute rotavirus gastroenteritis’ by Mete et al. [1]. The authors concluded that decreased MPV level is associated with rotavirus gastroenteritis and could be used as a negative acute phase reactant in children with this disease. We would like to thank the authors for their invaluable contributions.

MPV describes the size of platelets and is also a marker of inflammation [2, 3]. Moreover, elevated MPVs have been found to be related to thrombocytopenia, inflammatory disorders, cardiopulmonary diseases, while lower MPV values have been described in patients with inflammatory bowel diseases, anemia, chronic renal failure [3, 4].

There are also several studies assessing the relationship between infections and MPV. For instance, elevated MPV is related to tuberculosis, Crimean Congo Hemorrhagic Fever (CCHF), hepatitis B and C viruses whereas, decreased MPV is associated with some infections including sepsis, trichinellosis, HIV and RSV [4].

Rotavirus is a major enteropathogen all over the world, which frequently influence children less than five years of age in both industrial and developing countries [5]. Outbreaks are common and may cause serious infections, renal shutdown and even death [5]. Rotavirus gastroenteritis is an inflammatory condition and should be evaluated as other inflammatory illnesses. In this context, it is reported that, when there is an active inflammatory disease such as ulcerative colitis, platelet counts rise due to increased inflammatory cytokine activity and breakdown of these increased larger young platelets in inflammation area lowers MPV [1]. As the authors indicated, the decreased MPV in patients with rotavirus gastroenteritis in this study might be associated with high levels of active inflammation.

The strength of this study comes from its being prospective, treatment of pediatric patients without antibiotic use and specifying the elapsed time between taking the blood samples and measuring MPV values without any delay. On the other hand, detailed microbiological assessment is crucial. Stool culture is not sufficient since most of the viral and bacterial microorganism cannot be identified by this method. Molecular biology techniques should be used to address this gap in our knowledge to illuminate the other bacterial and small viral pathogens. In addition, the children with acute gastroenteritis might have secondary viral or bacterial infections. These factors may affect MPV levels. Therefore, it would have been accurate, if the detailed information was presented about gastroenteritis due to non rotavirus as well as the secondary infections in the patient group.

In conclusion, further studies are required to determine the associations between MPV and rotavirus gastroenteritis. For instance, repeated measurements of MPV are crucial and may be performed in future studies to avoid false high and low readings. We think that MPV should be assessed with other inflammatory markers (e.g. C-reactive protein, erythrocyte sedimentation rate) to provide the required information.

Declaration of interest

The authors have no competing interests to declare.