A Study of the Mean Platelet Volume and Plasma Fibrinogen in Type Two Diabetes Mellitus Patients Versus Healthy Controls and Their Role as Early Markers of Diabetic Microvascular Complications

Background Mean platelet volume (MPV) is considered an emerging biological marker of platelet function and activity. Higher MPV has been scientifically linked to diabetes mellitus, metabolic syndrome, stroke, and coronary artery disease. Plasma fibrinogen is a circulating glycoprotein, serving as an acute inflammatory marker ultimately leading to enhanced atherogenic plaque formation. We conducted this study to evaluate the crucial role of MPV and plasma fibrinogen, which showed elevated levels in diabetes mellitus patients compared to non-diabetic healthy individuals. This study also elaborates on the pivotal role that MPV and plasma fibrinogen levels play in the pathogenesis of microvascular complications, which progress and eventually lead to mortality in patients with type 2 diabetes mellitus. Methodology This study is a single-center hospital-based study including 120 type 2 diabetes mellitus patients and 120 healthy non-diabetic individuals. It is a cross-sectional and observational study. The study was conducted over a period of one and a half years in a medical college and hospital in a semi-urban locality in Western Maharashtra, India. We obtained informed written consent from the patients. All patients underwent thorough clinical assessment, and data were collected using proformas, which were later tabulated and entered in Microsoft Excel sheets. Later, the statistical data analysis was performed. Plasma fibrinogen was performed by photo-optical clot detection. MPV was analyzed by coulter principle in the central laboratory department of the parent institute. Patients above 18 years with cases of type 2 diabetes mellitus with or without any related complications, while the controls are healthy non-diabetic individuals attending the outpatient and inpatient departments of General Medicine. We excluded patients under the age of 18 years, those diagnosed with type 1 diabetes mellitus, hematological conditions associated with anemia and abnormal platelet counts, pregnant females, any acute or chronic infections, patients currently on antiplatelet medication and other drugs affecting the platelets, and all critical patients. Results The majority of patients in our study were in the age group of 41-50 years, with 49.2% having one or more microvascular complications of diabetes mellitus. In our study, out of 120 cases, 3.3% and 23.3% had raised MPV and fibrinogen levels, respectively, above the normal range. When compared with males and females, there was no statistically significant difference in the mean value of MPV and fibrinogen. On the t-test (p < 0.05), there was a statistically significant difference in the mean value of MPV and fibrinogen level between diabetics with and without microvascular complications. The t-test (p < 0.05) showed that there was a statistically significant difference among cases in the mean values of MPV and plasma fibrinogen in relation to retinopathy, nephropathy, and neuropathy, which are all microvascular complications of diabetes. Conclusion The study reveals higher levels of MPV and fibrinogen in diabetic patients compared to non-diabetic healthy individuals. In addition, higher levels of MPV and fibrinogen were present in patients with microvascular complications, correlated with age and diabetes duration.

Mean Platelet Volume as a Marker of Vasculogenic Erectile Dysfunction and Future Cardiovascular Risk

Cardiovascular diseases are the main cause of mortality in the Western population, so the attempt to find a marker capable of predicting their early onset is not surprising. It is known that arteriogenic erectile dysfunction (ED) precedes the onset of a major coronary event by several years. However, a marker that is able to early identify those patients who should undergo further diagnostic investigations is, to date, missing. Recent research on this topic has focused on the role of the mean platelet volume (MPV), a marker of platelet activity that is high in most vascular diseases, such as coronary artery disease (CAD), stroke, peripheral artery disease (PAD), and ED. The basic pathophysiological mechanism of all these clinical conditions is atherosclerosis. Platelets play a central role in amplifying this process both indirectly by stimulating endothelial cells to produce inflammatory cytokines and chemokines, and directly through the expression of membrane receptors and the release of molecules that contribute to the formation of atherosclerotic plaque. The objective of this review is to critically analyze the evidence on the role of MPV in predicting the diagnosis and severity of vasculogenic ED and the possibility of using this simple marker as a first step to start a diagnostic process aimed at assessing the cardiovascular risk in these patients.

Relation Between Oxidative Stress and Hematologic Abnormalities in Children With Type 1 Diabetes

OBJECTIVES

Recently, numerous studies have renewed attention to the hematologic profile in the early identification of diabetic inflammation and complications. The objective of this study was to investigate the relationship between hematologic indices abnormalities and oxidative stress among children with type 1 diabetes mellitus (T1DM).

METHODS

This study included 70 children diagnosed with T1DM and 30 healthy control subjects. The children with T1DM were divided into 2 groups according to the duration of diabetes: children with newly diagnosed T1DM and children with established T1DM.

RESULTS

Erythrocyte count and platelet count were decreased significantly in children with established T1DM, whereas leukocyte count and neutrophil count were increased significantly in children with newly diagnosed T1DM compared with healthy control subjects. Moreover, hemoglobin and hematocrit values revealed a significant depletion in both T1DM groups; however, values of red blood cell distribution width, mean platelet volume and platelet distribution width were significantly elevated in both T1DM groups compared with healthy control subjects. Also, microalbuminuria levels showed a significant increase in children with established T1DM, whereas lipid peroxidation biomarker (malondialdehyde) and nitric oxide levels were elevated markedly in both T1DM groups compared with the healthy group.

CONCLUSIONS

The data demonstrated that the hematologic profile showed noticeable alterations in children with T1DM, and the inflammation and oxidative stress markers were contributed to the hematologic abnormalities. The results revealed that some hematologic indices can be used in the early detection of children with T1DM at risk for diabetic complications.

A Study of Platelet Indices in Type 2 Diabetes Mellitus Patients

Altered platelets have been reported in patients with diabetes mellitus and has been considered as a 'prothrombotic state' with enhanced platelet reactivity. They have been associated with increased risk of vascular complications in these patients. Platelet indices correlate with functional status of platelets and is an emerging risk factor of vascular complications in diabetes. The study was undertaken to know the efficacy of platelet analysis in assessing the prognosis of diabetes mellitus. A prospective hospital based study of platelet parameters MPV, PDW and P-LCR was carried out on 280 cases diagnosed with Type 2 diabetes Mellitus and 280 controls with normal blood glucose levels. The blood glucose levels and HbA1c level were also measured. Statistical evaluation was performed by using Student's unpaired t test and Pearson correlation test. The average age of presentation with type 2 diabetes mellitus was 53 ± 5.7 years. The mean duration of diabetes was 4.7 ± 2.5 years. MPV, PDW and P-LCR were significantly higher in diabetics compared to non diabetics (11.3 ± 1.0 vs. 9.0 ± 0.6, 14.2 ± 2.5 vs. 10.7 ± 0.7 fl, 35.0 ± 8.1 vs. 23.0 ± 2.4%). Among the diabetics, MPV, PDW and P-LCR were higher in those with complications as compared to those without complications, which was not statistically significant. The higher values of MPV, PDW and P-LCR indicates that they serve as better risk indicator of initial vascular complications in diabetes mellitus patients and can be used as a simple and cost effective tool to assess vascular events.

Platelet function in diabetic and nondiabetic patients with chronic obstructive pulmonary disease: a case control study

BACKGROUND

The effect of association between chronic obstructive pulmonary disease (COPD) and diabetes (DM) on platelet function has not been studied before.

OBJECTIVES

To evaluate the effect of the association between COPD and DM on platelet function and C reactive protein (CRP).

PATIENTS AND METHODS

This case control study was carried out on 110 stable COPD patients who were classified into diabetic and nondiabetic groups. In addition, 40 apparently healthy, age and sex-matched individuals were included in this study as a control group. Chest X-ray, pulmonary function testing and arterial blood gases were done for COPD patients. CRP and complete blood count (CBC) were measured in both patient and control groups.

RESULTS

Mean platelet volume (MPV), platelet distribution width (PDW), platelet crit (PCT) and CRP were significantly higher in COPD patients either nondiabetic or diabetic compared to control group. Moreover, MPV and CRP markers were significantly higher in COPD diabetic patients compared to nondiabetic. There was no significant difference in various laboratory data among different stages of COPD either diabetic or nondiabetic (P > 0.05). In COPD patients, MPV was a significantly positively correlated with CRP and PDW (r = 0.346, P < 0.001; r = 0.510, P < 0.001, respectively) and negatively correlated with PLT count (r = -0.294, P = 0.002).

CONCLUSION

MPV, PDW, PCT and CRP were significantly higher in COPD patients either nondiabetic or diabetic. Platelet function may be modified by the systemic inflammation that associated with COPD. Platelet activation as a prothrombotic sequence of this disease may be used as novel therapeutic target.

Effects of Glucose Control on Hematological Indices in Patients with Diabetes Mellitus

Aim: We aimed to investigate the effects of diabetes treatment modalities on haematological parameters and leukocyte formula in patients with type 2 diabetes mellitus.Materials and Methods: The study included 102 patients with type 2 diabetes, out of which 51 receiving insulin treatment and 51 receiving oral antidiabetics (OAD). Hemogram data of insulin and OAD treated groups were compared.Results HbA1c levels were 11.12 ± 2.09 mg/dl in insulin group and 7.94 ± 2.1 mg/dl in OAD group p=0.001. Platelet counts were 27866.67 ± 77693 109/L before treatment and 258941.18 ± 69068.2 109/L in OAD group at six months, p: 0.015 whereas; 293011.76 ± 73711.21 109/L before treatment and 289492.86 ± 82631.49 109/L in insulin group at six months p: 0.821. Monocyte counts were 0.47 ± 0.12 109/L before the treatment and 0.57 ± 0.12 109/L in mix insulin therapy subgroup at six months, p:0.004; monocyte percentage was % 6.11 ± 1.74 before the treatment and %7.51 ± 2.57 in mix insulin subgroup at six months p:0.039;  Basophiles counts were 0.1 ±  0.02 109/L before treatment and 0.09 ± 0.04 109/L in intensive insulin therapy subgroup at six months, p: 0.005; Lymphocyte and basophils counts were significantly decreased at six months insulin treatment as compared to the pretreatment values.Conclusion: This study showed that, glucose control effects; blood indices HbA1C, basophiles, eosinophils, platelets and lymphocytes counts.

Can mean platelet volume levels of trauma patients predict severity of trauma?

Abstract In this study, we aimed to evaluate the mean platelet voulme (MPV) levels of trauma patients who were admitted to our emergency department. Of the total 232 trauma patients, 40 females and 192 males over the age of 18 years were included in this study. Of them, 102 patients were mild trauma [Glasgow Coma Scale (GCS) 15-13)], 40 patients were moderate (GCS 12-9) and 90 patients were severe trauma (GCS 8-3) patients. We also calculated the Revised Trauma Score (RTS) of the patients. MPV levels were evaluated with GCS and RTS values. The control group was constituted of 100 healthy adults. Mean initial MPV value of GCS 15-13 patients was 8.25 fL, 8.25 fL in GCS 12-9 patients and 8.47 fL, in GCS 8-3 patients. Trauma severity was significantly related with initial MPV (iMPV) levels (p<0.05), initial Hb (iHb) levels (p<0.05), initial white blood count (iWBC) (p<0.05) and initial platelet (iPlt) levels (p<0.05). Severity of trauma was related with control MPV (kMPV) levels (p<0.05), control Hb (kHb) (p<0.05), control WBC (kWBC) (p<0.05), control Plt (kPlt) levels (p<0.05). MPV levels (p<0.05), Hb levels (p<0.05), WBC levels (p<0.05), Plt levels (p<0.05) were significantly different between trauma group and healthy group. IMPV and control kMPV levels were not related (p=0.149). But kHb - iHb levels (p<0.05), kWBC - iWBC levels (p<0.05), kPlt - iPlt levels (p<0.05), kGCS - iiGCS (p<0.05) were related to each other. We found a correlation between iMPV and iWBC levels (p<0.05, r=-0.342). Similarly, there was a correlation between severity of trauma and iMPV level (p<0.05, r=-0.224). We determined a significant correlation between iMPV and iPlt levels (p<0.05, r=-0.246). There was not a correlation between kMPV and kWBC (p>0.05, r=0.124). kMPV and kPlt levels (p<0.05, r=-0.174) were correlated. RTS was statistically related with GCS (p<0.05). Similarly, RTS was related with iMPV (p<0.05), iWBC(p<0.05) and iPlt (p<0.05) values, but there was not a relation with iHb (p>0.05). We found correlations between iMPV- trauma severity (p<0.05, r=-0.224), iMPV - RTS (p<0.05, r=0.134), iMPV - iWBC (p<0.05 r=-0.342), iMPV - iPlt (p<0.05, r=-0.246). Control RTS (seventh day of hospitalization) values were not related to kMPV (p>0.05), kHB (p>0.05), kWBC (p>0.05) and kPlt(p>0.05). There was a correlation between kRTS and kMPV (p<0.05, r=-0.169). Similarly, kMPV - kHb (p<0.05, r=-0.141), kMPV - kPlt (p<0.05, r=-0.174) were correlated. KMPV and kPlt were not correlated (p<0.05, r=0.124). Initial RTS and seventh day RTS values were significantly different (p<0.05). MPV may be helpful for emergency physicians for predicting the severity of trauma.

Normal range of mean platelet volume in healthy subjects: Insight from a large epidemiologic study

AIM

Mean platelet volume (MPV) in the healthy population has not been studied before. Therefore, the aim of the study was to measure MPV in normal subjects in a large cohort of Turkish adults.

METHODS

A total of 2298 subjects with a mean age of 50 (age range 18 to 92) were interviewed. Subjects who had smoking habit, diabetes, hypertension, coronary artery disease, dyslipidemia, chronic obstructive pulmonary disease, cancer, chronic use of any drugs including antiplatelets, heavy drinkers, metabolic syndrome, ejection fraction <55%, creatinine >1.4 in men and >1.1 in women, abnormal liver function tests and an abnormal TSH were excluded in a in a stepwise manner. Complete blood counts were done on the same day within 6 hours by a CELL-DYN 3700 SL analyzer (Abbott Diagnostics).

RESULTS

Three hundred twenty-six participants (204 females (63%) and 122 males (37%) with a mean age of 41 ± 16) constituted the final healthy cohort. Mean MPV of the cohort was 8.9 ± 1.4 fL. There was no significant difference among age groups regarding MPV.

CONCLUSION

Ninety-five percent of the individuals had a MPV between 7.2 and 11.7 fL. A patient having a MPV beyond this range should be evaluated carefully especially for occlusive arterial diseases.