[Evaluation of platelet indices for differential diagnosis of thrombocytosis by ADVIA 120].
ABSTRACT For the diagnosis of essential thrombocythemia (ET), no single clinical or laboratory finding of diagnostic value is available and a differential diagnosis of other myeloproliferative neoplasms or reactive thrombocytosis (RT) is needed. Following recent developments in automated blood cell analyzers, various platelet indices can now be measured. In this study, we analyzed whether platelet counts and 6 platelet indices can be used for the differentiation of ET from RT in patients with a platelet count of 600x10(3)/microL or more.
The subjects studied were 31 patients with ET and 224 patients with RT. The platelet counts, mean platelet volume (MPV), plateletcrit (PCT), platelet distribution width (PDW), mean platelet mass (MPM), mean platelet component concentration (MPC) and large platelets (LPLT) were measured by ADVIA 120 (Bayer Diagnostics, USA). The mean values of each item were compared between the two patient groups and the sensitivity and specificity of each item in the diagnosis of ET were determined by ROC curve analysis.
In essential thrombocythemia, all parameters except MPC were significantly higher than in reactive thrombocytosis. For the diagnosis of ET, the sensitivity and specificity were: 74.2% and 84.4%, when the platelet count was > or = 820 x 10(3)/microL; 80.6% and 80.0%, when the plateletcrit was > or = 0.63%; and 64.5% and 99.1%, respectively, when LPLT was > or = 23 x 10(3)/microL.
The platelet counts and platelet indices are useful for the differential diagnosis of thrombocytosis. The plateletcrit and LPLT are particularly useful for the diagnosis of ET when the platelet count is markedly increased.
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ABSTRACT: The lack of diagnostic certainty in some patients makes it difficult to distinguish between primary and secondary forms of thrombocytosis. To augment current diagnostic studies for thrombocytosis, we retrospectively evaluated clinical records and bone marrow trephine specimens of 183 patients with thrombocytosis-164 with essential thrombocythemia (ET), 19 with reactive thrombocytosis (RT)-for bone marrow angiogenesis, bone marrow megakaryocyte c-Mpl staining, and morphologic evidence of megakaryocyte proliferation. Angiogenesis was increased in patients with ET compared with healthy controls (P <.0001) and patients with RT (P =.006). In addition, an increase in angiogenesis was associated with certain disease features such as splenomegaly (P =.004) and reticulin fibrosis (P =.005). Decreased megakaryocyte c-Mpl staining was observed in a heterogeneous pattern in ET compared with healthy controls (P <.0001) and RT (P <.0001). Histologic stratifying criteria incorporating increased angiogenesis, decreased megakaryocyte c-Mpl expression, and marked megakaryocyte proliferation in the bone marrow was highly sensitive (97%) and specific (95%) for distinguishing ET from RT (P <.0001). However, with the current duration of follow-up available on the patients, none of the histologic features evaluated have yet demonstrated prognostic value for subsequent clinical course, vascular events, or survival.Blood 06/2002; 99(11):4131-7. · 9.06 Impact Factor
- Clinical and Laboratory Haematology - CLIN LAB HAEMATOL. 01/2001; 23(3):181-186.
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ABSTRACT: The results of the Coulter counter S plus II platelet volume analysis were studied in 100 patients with reactive thrombocytosis (platelet count greater than 500 X 10(9)/l), in 30 patients with myeloproliferative thrombocytosis, and in 32 patients with chronic myeloproliferative disease and a platelet count less than 500 X 10(9)/l. Patients with reactive thrombocytosis had considerably lower mean platelet volumes than those with myeloproliferative thrombocytosis, or normal subjects. The opposite was true for the platelet distribution width. This index for platelet heterogeneity was normal in reactive, but increased in myeloproliferative thrombocytosis. There were no differences in mean platelet volume or platelet distribution width between patients with myeloproliferative disease and a high or normal platelet count. The increased platelet heterogeneity in myeloproliferative disease was caused by an increase of both small and large platelets. The platelet distribution width seemed to be the best variable for the differential diagnosis of thrombocytosis. A platelet distribution width greater than 17 was found in 26 of the 30 patients with myeloproliferative thrombocytosis but in only five of the 100 patients with reactive thrombocytosis. A normal platelet distribution width in a patient with a high platelet count strongly suggests reactive thrombocytosis.Journal of Clinical Pathology 03/1986; 39(2):129-33. · 2.44 Impact Factor