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Title: Platelet Indices as a Tool for Differentiation between Clonal Thrombocytosis and Reactive Thrombocytosis
Authors: Ammara Hafeez, Nasir ud Din Khattak, Samina Naeem, Helen Mary Robert, Shamaila Mohsin, Amal Mahmood
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2023
Volume: 73
Issue: Supplementary 1
Language: English
DOI: 10.51253/pafmj.v73iSUPPL-1.6350
Keywords: InfectionAnemiaClonal thrombocytosisMean platelet volumePlateletcritPlatelet distribution widthReactive thrombocytosis
Objective: To determine the efficacy of platelet indices as a tool for differentiation between clonal thrombocytosis and reactive thrombocytosis.
Study Design: Cross sectional study.
Place and Duration of Study: Department of Pathology, Combined Military Hospital, Lahore Pakistan, from Nov 2019 to Oct 2020.
Methodology: Fifty-six subjects were included in Reactive thrombocytosis group and 56 in Clonal thrombocytosis group. Fresh blood in EDTA anticoagulant was analyzed to determine complete blood counts and platelet parameters (Platelet distribution width, mean platelet volume, Platelet large cell ratio, Plateletcrit) using the automated hematological analyzer Sysmex KX-21.
Results: Mean age of the patients was 45.76 years with a range of 17-75 years. Assessing the cause of reactive thrombocytosi revealed that 20(35.7%) was infection and 16(28.5%) was iron deficiency anemia. In clonal thrombocytosis group 21(37.5%) were diagnosed with Chronic myeloid leukemia, 13(23.2%) with Essential thrombocythemia and 14(25%) with Polycythemia rubera vera. Platelet indices were compared in clonal thrombocytosis group and the reactive thrombocytosis group. Mean platelet volume, Platelet large cell ratio and Plateletcrit were significantly higher in the clonal thrombocytosis group (p=0.001). Difference in Platelet distribution width was not found to be statistically significant in the two groups (p=0.07)
Conclusion: Platelet indices were higher in the clonal thrombocytosis group. Along with platelet count, they can serve as an efficient and cost-effective method in differentiating between clonal and reactive thrombocytosis.
To determine the efficacy of platelet indices as a tool for differentiation between clonal thrombocytosis and reactive thrombocytosis.
A cross-sectional study was conducted at the Department of Pathology, Combined Military Hospital, Lahore, Pakistan, from November 2019 to October 2020. Fifty-six patients were included in the reactive thrombocytosis group and 56 in the clonal thrombocytosis group. Complete blood counts and platelet parameters (Platelet distribution width, mean platelet volume, Platelet large cell ratio, Plateletcrit) were analyzed using the automated hematological analyzer Sysmex KX-21. Statistical analysis was performed using SPSS version 26.0, with independent samples t-test for comparing mean values and Chi-square test for clinical parameters. ROC curves were used to assess cut-off values.
graph TD;
A["Study Design: Cross-sectional"] --> B["Patient Recruitment: 56 Reactive, 56 Clonal"];
B --> C["Blood Sample Collection"EDTA""];
C --> D["Analysis using Sysmex KX-21"];
D --> E["Complete Blood Count & Platelet Parameters"];
E --> F["Statistical Analysis t-test, Chi-square, ROC"];
F --> G["Results Interpretation"];
G --> H["Conclusion: Efficacy of Platelet Indices"];
The study suggests that platelet indices, particularly MPV, P-LCR, and PCT, are elevated in clonal thrombocytosis compared to reactive thrombocytosis. This differentiation is clinically important as clonal thrombocytosis is associated with a higher risk of thromboembolic and bleeding complications. The findings support the use of these indices as a cost-effective method to distinguish between the two conditions, potentially reducing the need for more invasive or expensive diagnostic procedures like genetic testing.
Mean platelet volume (MPV), Platelet large cell ratio (P-LCR), and Plateletcrit (PCT) were significantly higher in the clonal thrombocytosis group (p=0.001). The difference in Platelet distribution width (PDW) was not statistically significant between the two groups (p=0.07). In reactive thrombocytosis, infection was the most common cause (35.7%), followed by iron deficiency anemia (28.5%). In clonal thrombocytosis, chronic myeloid leukemia (CML) was diagnosed in 37.5%, essential thrombocythemia (ET) in 23.2%, and polycythemia rubera vera (PRV) in 25%.
Platelet indices (MPV, PCT, and P-LCR) are higher in the clonal thrombocytosis group. Along with platelet counts, they can serve as an efficient and cost-effective method for differentiating between clonal and reactive thrombocytosis.
1. Sample Size: The study included a total of 112 patients, with 56 in the reactive thrombocytosis group and 56 in the clonal thrombocytosis group.
2. Causes of Reactive Thrombocytosis: Infection was identified as the cause in 35.7% of reactive thrombocytosis cases, and iron deficiency anemia in 28.5%.
3. Significance of MPV, P-LCR, PCT: These platelet indices were found to be significantly higher in the clonal thrombocytosis group (p=0.001).
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