From the Guidelines
High MPV with thrombocytopenia typically indicates increased platelet turnover, where the body is producing larger, younger platelets in response to peripheral destruction or consumption, and the most common causes include immune thrombocytopenia (ITP), disseminated intravascular coagulation (DIC), and thrombotic microangiopathies like TTP or HUS, as well as bone marrow disorders, certain medications, severe infections, and liver disease with portal hypertension causing splenic sequestration 1.
Causes of Elevated MPV and Thrombocytopenia
The causes of elevated Mean Platelet Volume (MPV) and thrombocytopenia can be categorized into several groups, including:
- Immune-mediated disorders, such as immune thrombocytopenia (ITP), where autoantibodies target platelets for destruction 1
- Bone marrow disorders, such as myelodysplastic syndromes, which can lead to decreased platelet production 1
- Certain medications, such as heparin, quinine, and sulfonamides, which can cause thrombocytopenia 1
- Severe infections, such as HIV, HCV, and other viral infections, which can lead to thrombocytopenia 1
- Liver disease with portal hypertension, which can cause splenic sequestration and thrombocytopenia 1
- Inflammatory conditions, such as lupus or rheumatoid arthritis, which can contribute to thrombocytopenia through immune-mediated mechanisms 1
Management and Evaluation
Management of elevated MPV and thrombocytopenia depends on identifying and treating the underlying cause, which may require:
- Blood tests, including complete blood count with peripheral smear, coagulation studies, and sometimes bone marrow examination 1
- Urgent evaluation is necessary as some causes like TTP require immediate intervention with plasma exchange to prevent serious complications 1 It is essential to note that the evidence from the studies 1 suggests that the management and evaluation of elevated MPV and thrombocytopenia should prioritize the identification and treatment of the underlying cause, rather than just focusing on the symptoms.
Key Considerations
When evaluating and managing elevated MPV and thrombocytopenia, it is crucial to consider the following:
- The potential for life-threatening complications, such as bleeding or thrombosis, and the need for urgent evaluation and treatment 1
- The importance of identifying and treating the underlying cause, rather than just managing the symptoms 1
- The need for a comprehensive diagnostic workup, including blood tests and sometimes bone marrow examination, to determine the underlying cause of elevated MPV and thrombocytopenia 1
From the Research
Causes of Elevated Mean Platelet Volume (MPV) and Thrombocytopenia
- Thrombocytopenia may result from mechanisms such as marrow hypoplasia, increased destruction of platelets, and splenic sequestration 2
- Elevated MPV is associated with hyper-destructive thrombocytopenia, which includes conditions such as immune thrombocytopenia purpura (ITP) 3, 4, 5
- In ITP patients, MPV is higher than in healthy individuals and can be used as a predictor of response to first-line treatment 3
- MPV, along with other platelet indices such as platelet distribution width (PDW) and platelet large cell-ratio (P-LCR), can help discriminate between hypo-productive and hyper-destructive thrombocytopenia 4, 5
- A cut-off value of MPV ≥8.8 fL has been suggested to indicate over-destructive thrombocytopenia with acceptable sensitivity and specificity 5
- Thrombocytopenia is a common feature of myelodysplastic syndromes (MDS) and can be treated with thrombopoietin receptor agonists such as romiplostim and eltrombopag 6
Platelet Indices in Thrombocytopenia
- Platelet indices such as MPV, PDW, and P-LCR are higher in hyper-destructive thrombocytopenia compared to hypo-productive thrombocytopenia 2, 4
- MPV and P-LCR have a larger area under the receiver operating characteristic (ROC) curve, indicating better predictive capacity and sensitivity in discriminating between hypo-productive and hyper-destructive thrombocytopenia 4
- A significant negative correlation has been observed between platelet count and platelet indices in ITP patients 4