A prospective study of platelet indices and their interpretation in thrombocytopenia in a tertiary care hospital

Abstract

Introduction: Thrombocytopenia is a significant finding in hospitalized patients who may be often missed if platelet parameters are not evaluated routinely. Platelet count below 150 x 109 /L defines Thrombocytopenia, but this does not reveal the underlying pathology. During the evaluation of these patients, it is essential to identify the etiology, whether it is due to hypoproduction or peripheral destruction, which will have an impact on the proper management of the patients. For a long time, Bone marrow aspiration remained the gold standard method for evaluating the cause of Thrombocytopenia. The objective of the present study was to investigate the role of platelet indices in the differential diagnosis of thrombocytopenia.Materials and Methods: An observational cross-sectional study was undertaken for a period of one year from January 2019 to December 2019 in the Department of Pathology, Midnapore Medical College. All the blood samples of patients which were received in K3-EDTA anti-coagulated vacutainers in the laboratory were processed within one hour of collection using the 5-part automated hematology analyzer. (Pentra ES 60, Horiba Medical) From the analyzer generated reports, platelet count and platelet parameters i.e., mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR), and plateletcrit (PCT) were recorded, and platelet count was reassessed by peripheral blood smear examination on Leishman stained slides in all the cases. We included 155 patients of age more than one year with Thrombocytopenia (platelet count < 150 x 109 / L). The Control group included 71 persons who had all the haemogram parameters within normal limits. Results: A total of 155 patients with Thrombocytopenia after informed consent were included in the study. There were 65 % males and 35 % females in this study. Table I shows the age-sex-wise distribution of the cases with Thrombocytopenia. Our age group ranged from 1 - 80 years, with more than 54 % of the cases falling in the age group of 21 - 40 years. On analyzing the results only PCT showed a direct relationship with the decreased platelet count which was statistically significant (P-value < 0.05).Conclusion: Plateletcrit can help assess both quantitative as well as qualitative platelet disorders and there is direct relation between PCT and platelet count. Other parameters like PDW, P-LCR and MPV along with PCT can be used to interpret the mechanism behind the low platelet count, where high values of indices indicate increased breakdown of platelets in the bloodstream and low values are possibly due to impaired production due to primary or secondary bone marrow disease.