If you feel that any of our content is inaccurate, out-of-date, or otherwise questionable, please leave a comment or contact us at support selfhacked. Note that each number in parentheses [1, 2, 3, etc. Do you bruise more easily than others? If so, you may have a problem with your platelets, disk-shaped cell fragments that help stop bleeding.
A mean platelet volume MPV test can help determine your platelet size and activity. Higher or lower MPV may be a sign of bleeding disorders or bone marrow disease. Read on to learn more about what an MPV blood test can reveal about your health. When your platelets are not working properly, you may have an increased risk of bleeding and bruising. If more platelets are being produced in the body, their average size will usually increase as well.
This test can offer insight into your overall platelet function and activity. Platelets are tiny cell fragments that are formed from budding off of very large cells in the bone marrow called megakaryocytes [ 1 ]. Once platelets are in the bloodstream, they live for about 8 to 10 days and are then destroyed.
Around a third of all platelets are stored in the spleen [ 1 ]. The main function of platelets is to prevent excessive bleeding when we are injured. When you cut yourself, for example, platelets stick together to plug the site of injury. Other clotting factors are then recruited to the scene to prevent further bleeding [ 2 ]. Recent studies show that they also contribute to inflammation, defend against microbes, release growth factors to assist in wound healing, and help form new blood vessels [ 3 ].
Platelets come in different shapes and sizes. Newly produced platelets are usually larger while older platelets are smaller [ 4 , 5 , 6 , 3 ]. Also, when platelets are activated, they change from a disc-shaped cell into a spherical-shaped cell [ 7 ]. Since platelets become larger when the body is producing more of them, and vice versa, an MPV test can be used to check for issues with platelet production in the bone marrow or platelet destruction [ 8 , 9 ].
An MPV test is often included as part of a complete blood count CBC test , which assesses the overall composition of the blood and its individual components, including red blood cells , white blood cells , and platelets [ 10 ]. Your doctor will interpret the test in conjunction with your medical history and other test results.
There is some lab-to-lab variability in ranges due to differences in equipment, techniques, and chemicals used. A low MPV means that platelets are smaller than average. In general, smaller platelets tend to be older, so a low MPV may mean that bone marrow is not producing enough new platelets [ 11 ].
However, a low MPV on its own is not informative enough and must be looked at in conjunction with other tests to diagnose platelet-associated conditions. Causes shown below are commonly associated with low MPV.
Work with your doctor or another health care professional to get an accurate diagnosis. The cause may be due to an inherited tendency to not produce enough platelets, but the cause may also be unknown. In other cases, it is due to an underlying medical condition. If the blood platelet count falls below 20, per mcL, a person can begin bleeding spontaneously.
People who experience spontaneous bleeding may require a blood transfusion. Low platelet count increases the risk of death in people who have recently experienced a traumatic injury. Platelet count also tends to decline with age. A platelet count that is lower than it once was, or that is on the lower end of normal, may not be a cause for concern in an older adult—especially if there are no other symptoms. Changes in platelet count may mean that a person has a chronic illness or that there is an issue with the bone marrow.
It is generally not possible, however, to diagnose a medical condition based on platelet count alone. People should talk to a doctor about further testing if a blood test reveals low platelets. It is advisable to inform the doctor about any other symptoms, which can help narrow down testing options. When the cells in the blood do not function as they should, it is possible a person has a blood disorder.
Examples include leukemia, lymphoma, and…. Microcytic anemia occurs when the body does not get enough oxygen and cannot provide enough energy to all organs and tissues, causing pale skin and…. If levels are low, it can be an indicator that certain elements of the…. Thin blood is the opposite of thick blood, which can increase the risk of blood clots and complications, such as stroke. Thin blood can lead to…. A red cell distribution width RDW blood test can help detect the presence of anemia, along with what could be causing it.
The test identifies the…. What do high or low platelet count levels mean? Medically reviewed by J. Keith Fisher, M. Platelet count blood test What to expect Platelet count is high Platelet count is low Takeaway A platelet blood count is a blood test that measures the average number of platelets in the blood.
What is the platelet count test? What to expect. However, in patients with ongoing inflammation, the increasing concentration of proinflammatory cytokines, mainly IL-6, can lead to platelet release. This is associated with the stimulation of thrombopoietin generation by IL-6 and with a direct effect of this cytokine on megakaryocytes. IL-6 causes an increase in the ploidy of megakaryocytic nuclei and an increase in cytoplasm volume, which in consequence leads to the production of a large number of blood platelets [ 56 ].
The course of an inflammatory condition is also associated with increased percentage of large platelets, probably due to intracellular synthesis of procoagulatory and proinflammatory factors, degranulation of granules, and initiation of the platelet pool stored in the spleen [ 57 ]. Simultaneously, these cells rapidly migrate to the site of inflammation where they undergo activation and wear [ 58 ].
This seems to explain the drop in MPV in patients with ongoing inflammation [ 59 ]. It is currently suggested that changes in MPV can be considered and used as a prognostic factor in a number of inflammatory diseases. It has been shown that hyperreactivity of blood platelets markedly increases individual susceptibility of patients to acute cardiac incidents. A study conducted by Endler et al. The presence of large and reactive platelets also increases the risk of thrombus formation after atherosclerotic plaque rupture [ 2 , 60 ].
Potential effects of diabetes, smoking, and hypertension on MPV have also been considered in the study. The authors suggest that can also be an independent risk factor of heart infarct in patients with coronary disease and designate patients threatened with acute cardiac incidents.
Also, Slavka et al. They showed that standard treatment, i. Huczek et al. This allows designation of a subgroup of patients with , in which mortality rate is considerably higher in a six-month period after the procedure [ 4 ].
In turn, Shah et al. However, the increase in MPV after the procedure was associated with higher risk of death within a long time, assessed in a series of measurements performed to evaluate the dynamics of changes in MPV. On the other hand, Gladwin and Martin [ 61 ] demonstrate that hypoxia increases the production as well as destruction of blood platelets, leading to MPV growth.
A similar increase in platelet turnover caused by the action of prionflammatory cytokines can be observed in diabetic patients and smokers [ 62 ].
These observations can explain the fact that antiplatelet therapy reduces the risk of complications and in the future also cardiovascular incidents in patients undergoing heart revascularization procedure [ 55 , 63 ]. High MPV values are also encountered in patients with acute cerebrovascular ischemia. Butterworth and Bath [ 64 ] showed increased platelet volume 3 months after severe stroke.
Moreover, MPV did not correlate with a six-month survival of patients. Interestingly, D'Erasmo et al. The authors reported higher mortality among patients with significantly increased MPV than in patients who survived.
The authors suggest a possible use of MPV determinations as a prognostic marker in patients after stroke [ 6 , 8 ]. Differences in platelet size have also been observed in respiratory diseases, accompanied by an inflammatory condition. In active tuberculosis, cellular body immunity is stimulated. Therefore, reactive thrombocytosis is observed in tuberculosis, in which increased platelet count and size are associated with inflammation intensity [ 9 , 10 ].
Contrary to the stable form, during disease exacerbation, the MPV is significantly reduced. The decrease in MPV can be related to the formation of microthrombi in tuberculous cavities, which are to inhibit the disease spread and are considered a defense reaction [ 27 ].
It has been suggested that MPV can be a negative marker of the acute phase of inflammation, and a decrease in MPV can be caused by increased platelet count and their accelerated wear. Also, MPV is significantly higher in this group of patients. This may suggest the involvement of blood platelets in the development and course of the disease [ 11 ]. Chronic renal failure is frequently accompanied by reduced platelet aggregation and in consequence prolonged bleeding time.
The application of therapy with recombinant erythropoietin HuEPO significantly improves hemostasis but increases the risk of thrombotic events [ 65 ]. Receptors for EPO are observed on the surface of megakaryocytes and their activation promotes thrombocytopoiesis. Sharpe et al. The authors suggest that HuEPO stimulation causes a release of young thrombocytes that are larger and undergo activation and aggregation more easily, leading to higher risk of blood clot formation [ 12 ].
Zubcevic et al. On the other hand, the increased activity of ulcerative colitis is associated with MPV decrease [ 28 ]. However, not all studies seem to confirm the diagnostic usefulness of MPV in inflammatory diseases of the intestines. Kapsoritakis et al. They also found no correlation between the disease activity and MPV. In recent years, it is suggested that MPV can be linked to the activity of rheumatoid arthritis RA ; however, the data on this subject have still been controversial [ 67 ].
Yazici et al. Moreover, MPV can be used as a negative acute-phase biomarker in rheumatic diseases. The opposite results are presented by Moghimi et al. The authors stating that the limitation of their examination may be the small group of patients [ 70 ].
According to Gasparyan et al. Increased MPV is observed due to administration of anti-inflammatory drugs that modify the course of the disease or biological drugs anti-TNF alpha [ 15 ]. Study results showed higher MPC levels in pediatric patients as compared to the control.
El-Garf et al. Contrary to the results obtained in the group of children with juvenile SLE, adult patients with active disease had a statistically significant decrease in MPV values as compared to inactive SLE. Researchers suggest that this is due to the consumption of large active blood platelets during inflammation, although they also indicate that this is only a theory to be further confirmed by clinical research [ 29 ].
Altered platelet morphology, metabolism, and function were found also in diabetic patients [ 17 , 72 , 73 ], and higher platelet reactivity is the main factor responsible for increased risk and worse outcome in these patients [ 17 , 18 ]. Elevated MPV was reported in patients with diabetes and impaired fasting glucose subjects as compared to nondiabetes individuals [ 17 , 73 , 74 ].
In addition, Papanas et al. Interestingly, some authors showed that the percentage of glycated haemoglobin HbA1 C did not have any influence on MPV [ 76 ]. On the other hand, studies of Demirtunc et al. Recently, increasing attention has been paid to the assessment of MPV in cancer patients.
Neoplastic transformation is associated with a chronic inflammatory process, which may also affect platelet parameters. Hepatocellular carcinoma HCC is one of the most common primary cancers of the liver. The first symptoms of tumor growth are masked by chronic liver diseases CLD , such as cirrhosis or viral infections [ 19 ].
Kurt et al. The authors showed that MPV levels in patients with HCC were significantly higher as compared to patients with chronic hepatitis and in healthy subjects.
Moreover, the level of MPV was significantly higher in patients with liver cirrhosis and hepatocellular carcinoma as compared to patients suffering only from liver cirrhosis [ 19 ]. Thrombocytopenia and a significantly increased MPV in these patients may result from decreased activity of thrombopoietin and bone marrow suppression associated with chronic HCV infection and antiviral therapy application [ 80 ]. Also, Cho et al. In the study group, the marker was the highest among women.
According to literature data, studies concerning colorectal cancer and MPV yield divergent results. Moreover, no changes were noted in MPV between patients with and without colorectal cancer metastases. MPV was not found to correlate with cancer location and advancement [ 82 ]. On the other hand, research performed by Li et al.
Similar findings were reported by Tunce et al. They observed a significant increase in MPV in patients with metastases mCRC as compared to nonmetastatic colorectal cancer patients non-mCRC , suggesting that these differences result from considerable enhancement of the inflammatory process and platelet activation in more advanced metastatic disease.
At the same time, they failed to find any difference in the platelet count between the study groups of patients. They also showed that patients with decreased MPV before chemotherapy responded much better to the therapy applied, achieving longer remission [ 21 ].
Inanc et al. Prior to treatment, MPV findings were similar in the whole study group, although after three therapeutic cycles, the MPV values dropped in all patients. However, no differences were noted in MPV between patients undergoing various chemotherapies.
The authors indicate that changes in MPV could be due to the effect of chemotherapy on the formation of blood platelets and cyclic drug administration [ 30 ]. Gastric cancer is another gastrointestinal lesion accompanied by changes in the platelet parameters. It is characterized by early metastasis formation and high mortality [ 83 ]. The level of MPV did not correlate with the disease advancement. Following the surgery, the level of MPV underwent a significant reduction to the values comparable to control.
Research conducted by Shen et al. The researchers also observed a high preoperative level of MPV in patients and its significant decrease when the treatment was applied. The development of gastric cancer has been known to be closely associated with chronic inflammation accompanied by significantly elevated IL-6 concentration [ 84 ]. This cytokine via receptor binding on the surface of megakaryocyte progenitor cells causes their maturation and proliferation and in consequence enhances platelet release.
The authors suggest that the increased MPV in gastric cancer patients can be a sequel of inflammatory condition and the accompanying elevated level of IL Likewise, Matowicka-Karna et al. The authors demonstrated that MPV and PLT in patients in an early stage of cancer were similar to those found in healthy subjects and increased with the disease progression.
However, after tumor resection, a further increase was noted in the platelet count and the percentage of large platelets was elevated. The analysis of study results in patients with neuroendocrine tumor of the pancreas shows that prior to surgery the level of MPV was statistically significantly lower as compared to patients suffering from pancreatic adenocarcinoma.
Therefore, they emphasize that MPV can be a useful marker to differentiate between these two cancers [ 32 ]. In turn, a study conducted by Gong et al. After surgery, the MPV value decreased significantly. High value of the marker is a poor prognostic factor due to the release of growth and prothrombotic factors from platelets, which affect angiogenesis and progression of neoplastic disease [ 24 ]. Also, Yin et al. Zhang et al. The researchers searched for a prognostic factor in patients with squamous cell carcinoma of the esophagus, which could be determined in routine blood tests.
Their study results demonstrate that simultaneous determination of platelet count and volume has a higher prognostic value both at an early stage and in advanced disease, especially in the assessment of lymph node involvement.
The authors show that separate determination of platelet parameters has no such significance as COP-MPV, especially in the assessment of survival before surgical removal of esophageal tumor [ 85 ]. Changes in MPV were observed in patients with papillary thyroid cancer [ 50 ]. An increase in MPV was found even in small neoplastic lesions and correlated with tumor growth.
A positive correlation was noted between MPV and the level of thyroglobulin in these patients. The authors indicate that the increase in the parameter may also affect the risk of cardiovascular events and clot formation in the affected patients [ 26 ]. Some authors indicated that MPV was associated with renal cell carcinoma RCC [ 33 , 86 ] which is the most common kidney malignancy.
It was assessed whether the administration of antiangiogenic TKIs sunitinib, sorafenib, or pazopanib affects the MPV value in patients with renal cell carcinoma [ 86 ]. The results revealed elevated MPV levels after three months of treatment. The antiangiogenic therapy significantly prolongs survival without cancer relapse but at the same time increases the risk of thrombotic events in these patients.
It has been known that high MPV values also correlate with thrombosis in cancer patients, which is most probably associated with by far greater number of fibrinogen receptors on large thrombocytes. Therefore, the authors suggest a potential beneficial effect of antiplatelet drug administration in RCC patients treated with antiangiogenic TKIs [ 33 ]. In turn, Yun et al. However, the researchers put forward a few theories suggesting a likely cause.
They think that the inflammatory condition accompanying the carcinoma may lead to excessive platelet consumption and in consequence to MPV decrease, which has been confirmed lately [ 87 ]. The authors also indicate that a drop in MPV may result from blood platelet involvement in angiogenesis, migration, and invasion of cancer cells.
As revealed by literature analysis, an increase in MPV is observed in the majority of neoplastic diseases, although in some cancers, a decrease may be found. Inagaki et al. The authors believe that the decrease in these parameters is caused by inverse nonlinear correlation between platelet count and their volume.
This means that the enhanced release of blood platelets by megakaryocytes, stimulated by the action of the inflammatory cytokines IL-6 and IL-3, leads to a decrease in MPV. As we have already mentioned, some studies indicate that large-volume blood platelets are more reactive than the small ones and therefore undergo activation more rapidly, which leads to their faster consumption.
A study by Kumagai et al. Moreover, the authors assessed the prognostic value of MPV to show that low preoperative MPV level is an independent unfavorable prognostic factor in patients after total cancer resection [ 35 ]. Reduced MPV values were also observed in patients with cancer of the uterine cervix. The scientists reached the conclusions that low MPV values are independently related to the presence of cancer in the affected women and that the mechanisms leading to MPV reduction are unknown.
However, they put forward a few likely theories. One of them involves bone marrow dysregulation associated with cancer development and first of all with the production of considerable amounts of IL On the other hand, they point to platelet engagement in the formation of cancer metastases as a potential cause. However, these are only suggestions that require further molecular research [ 36 ]. However, also other factors like age, gender, race and ethnicity, lifestyle including diet , and genetic factors may strongly influence MPV and PLT [ 89 — 93 ].
Vasudeva and Munshi [ 94 ] in their review strongly highlight the role of genetic variants in platelet reactivity response at the site of injury of the vessel wall. Interindividual genetic variations of platelet reactivity in terms of PLT and MPV significantly modulate the course of thrombotic events.
Genetic variants are classified into 1 rare mutations variants with large effect, 2 common polymorphisms with small effects, and 3 polymorphisms with major effects. According to Kunicki et al.
By means of high-throughput techniques, e. However, the heritability of these genetic variations still remains not fully understood [ 90 ]. The abovementioned lifestyle changes were required from studied individuals for 20 weeks.
Authors showed that recommended approaches significantly reduced MPV in PHT subjects, which suggest that the style of living may play a role in decreasing platelet activation and may become an aspect of therapy in these patients.
However, their study cannot be extrapolated to all PHT individuals, as Yazici et al. Hou et al. Another large cohort study adult population of the United States , performed by Ijaz et al.
Also, Abudesimu et al. Authors found that risk factors for MPV included Uygur ethnicity, smoking, overweight, obesity, isolated systolic hypertension, isolated diastolic hypertension, diabetes, and high triglycerides [ 97 ].
Based on the obtained results, Abudesimu et al. Data concerning the MPV value depending on gender is conflicting [ 3 , 54 , 99 — ]. Some authors identified higher MPV values in women [ 54 , 99 , ], while others in men [ ]. We also can find studies reporting no significant differences for MPV value between women and men [ 3 , 88 , , , ].
According to some authors, also the hormonal profile may affect MPV value; however, also in this aspect, obtained results are contraindicatory [ — ]. Butkiewicz et al. They showed that PLT in healthy postmenopausal women without estrogen replacement therapy was lower than that in healthy women before menopause; nonetheless, for MPV, authors did not present any significant differences between the groups analyzed [ ].
Bulur et al. On the other hand, Panova-Noeva et al. The use of certain antithrombotic drugs may also affect MPV. It has been demonstrated that aspirin does not affect MPV, but no data are available on the potential effect of other antiplatelet drugs on changes in this parameter [ ]. Available literature presented in this subsection demonstrates that the aspect of multiple determinants influencing PLT and MPV in physiology and during disease state is not so easy to understand, as different factors may affect platelet reactivity Figure 1.
In the future, much effort also should be put into linking the role of genetic variations regulating platelet traits during different pathology conditions.
Nowadays, MPV evaluation is widely available in clinical laboratories as it is routinely measured within complete blood count CBC test. Although this parameter has been evaluated for many decades, the intercenter comparison of MPV still has been suffering from lack of standardization of the preanalytical as well as analytical procedures Figure 1 , different hematological analyzers and methods used, and the lack of universal external calibration [ — ].
Among the preanalytical factors that may influence MPV value, we can distinguish 1 the venipuncture method with or without stasis , 2 the appropriate filling of the tube with blood, 3 the accuracy of sample mixing, 4 the anticoagulant used for blood collection centrifugation of the blood collected into citrate anticoagulant may lead to platelet activation resulting in the presence of more active large platelets; the use of EDTA as an anticoagulant may cause platelet swell, which moreover is time-dependent , 5 the type of sample change in MPV value is smaller in platelet rich plasma compared to the whole blood.
Diversity of methods used for platelet morphology evaluation is another factor responsible for MPV value differences between laboratories [ ]. According to Jagroop and Mikhailidis [ ], more attention should be given to the interpretation of the MVP value depending on the method used for platelet size evaluation [ ]. Hematological analyzers generally are based on the impedance method or on the optical method with the use of laser light scatter [ ].
Some hematological analyzers may also use both or even more methods, e. On the contrary, a so-called giant platelet can be falsely interpreted as RBC [ , ]. This analytical bias may lead to falsely increased platelet count, which in turn causes inability to give an appropriate MPV value, or may result with giving a false MPV value, based only on the platelet population being measured [ ].
In optical analyzers, platelets are recognized based on their volume forward scatter and density side scatter [ ]. Using the optical method may result in a situation in which microcytes are counted as large platelets [ ].
To standardize platelet size definition, Latger-Cannard et al. However, still the reference method used for the evaluation of platelet size is a microscopic examination of the MGG blood smear with a parallel evaluation of the platelet morphology by an experienced cytologist [ ].
Another issue that should be taken into account is the aspect of the MPV threshold value, as the available literature presents different cut-off points depending on the method and hematological analyzer used [ — ]. Pathepchotiwong et al. Noris et al. Authors obtained the average MPV value 8. Similarly, Latger-Cannard et al. This clearly indicates the need to establish individual reference values for MPV by laboratories.
Finally, we do not have a universal external calibrator for MPV [ ], and moreover, the accuracy of MPV evaluation might be inadequate because of the control samples, which quality may worsen when getting close to the expiry date [ ].
Undoubtedly, to gain more benefits in terms of clinical purpose from MPV evaluation by means of hematological analyzer, the clinical laboratories should strive for standardization of both the preanalytical and analytical phases.
Only then the MPV value may have a chance to develop a broader clinical application. The study of MPV, which is a routine test performed during blood morphology, can provide important information on the course and prognosis in many inflammatory conditions. However, to gain more benefits in terms of a clinical purpose from MPV evaluation, the clinical laboratories should strive for standardization of both the preanalytical and analytical phases.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Article of the Year Award: Outstanding research contributions of , as selected by our Chief Editors. Read the winning articles. Journal overview. Special Issues. Academic Editor: Daniela Novick. Received 14 Nov Revised 26 Feb Accepted 28 Feb Published 17 Apr Abstract Platelet size has been demonstrated to reflect platelet activity and seems to be a useful predictive and prognostic biomarker of cardiovascular events. Introduction Thrombocytes are the smallest and yet extremely reactive blood morphotic components.
Table 1. Increased MPV in various diseases [ 2 — 26 ]. Table 2. Decreased MPV in various diseases [ 15 , 20 , 22 , 24 , 27 — 36 ].
Figure 1. References B. Linke, Y. Schreiber, B. Picard-Willems et al.
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