Management of Low Mean Platelet Volume (MPV)
Low MPV does not require treatment in itself—management should focus entirely on identifying and treating the underlying cause, with the most common etiologies being bone marrow suppression from cytotoxic drugs, sepsis, aplastic anemia, chronic renal failure, or splenomegaly. 1, 2
Diagnostic Approach
- Establish chronicity through serial MPV measurements rather than relying on a single isolated reading, as this provides significantly more clinical value 1
- Obtain a complete blood count with review of all platelet parameters to identify the pattern of abnormality 1
- Low MPV in the context of thrombocytopenia (normal, low, or even high platelet counts) indicates impaired platelet production from marrow hypoplasia, cytotoxic drug effects, sepsis, splenomegaly, aplastic anemia, or chronic renal failure 2
Treatment Based on Underlying Etiology
General Principles
- Avoid prophylactic platelet transfusions based on low MPV or platelet count alone—transfuse only for active bleeding or immediately before high-risk procedures 1
- Address the root cause: discontinue or adjust myelosuppressive medications when possible, treat underlying sepsis, manage renal failure, or address splenomegaly 2
Cirrhosis-Related Thrombocytopenia with Low MPV
- Do not routinely correct low platelet counts in cirrhosis patients, as platelet count alone does not predict bleeding risk 1
- Consider thrombopoietin receptor agonists (avatrombopag or lusutrombopag) specifically before high-risk procedures in cirrhotic patients with thrombocytopenia and low MPV 1
- Use rotational thromboelastometry rather than platelet count to assess actual bleeding risk before procedures in liver disease patients 1
Monitoring Strategy
- Perform serial MPV measurements over time to track response to treatment of the underlying condition 1
- Monitor complete blood counts to assess whether marrow function is recovering (rising MPV suggests increased platelet production) 2
Critical Pitfalls to Avoid
- Never transfuse platelets prophylactically based solely on low MPV values—this does not improve outcomes and wastes resources 1
- Do not assume bleeding risk from platelet count or MPV alone in liver disease; functional testing is superior 1
- Recognize that low MPV specifically indicates production problems, not consumption or destruction, which helps narrow the differential diagnosis 2