We read with a great interest the article by Demir et al. about the relationship between prognosis and the alterations of some hematologic parameters, including mean platelet volume in hospitalized patients diagnosed with Fournier gangrene.1 We would like to comment about the mean platelet volume results of this study.
First, the authors suggested that mean platelet volume was an indicator of platelet function and activation. At the present time, light transmission platelet aggregation is the gold standard test of platelet function, and none of the platelet parameters (including mean platelet volume) is accepted as a platelet function test. Also, some studies showed that there was no correlation between platelet parameters and platelet aggregation responses obtained with light transmission platelet aggregation.2
The authors found that mean platelet volume values were significantly higher after the first débridement and at the end of hospitalization in the nonsurvivor group than in the survivor group; therefore, they concluded that the mean platelet volume value after the first débridement and during discharge might be included among the prognostic scores of Fournier gangrene. However, the agreement of this suggestion seems impossible because the measurement of the mean platelet volume has not been standardized. The mean platelet volume is dependent on a number of variables, including time of analysis after sampling, method of analysis, anticoagulant used, and specimen storage temperature.3 The increments in mean platelet volume values are time dependent because of ethylenediaminetetraacetic acid exposure, and maximal changes occur within the first 2 hours after sampling. Different studies reported widely ranging mean platelet volume changes from 2 to 50 percent when ethylenediaminetetraacetic acid was used as an anticoagulant.3 , 4 The various techniques of different instruments for measuring the mean platelet volume lead to variable results also.4 A meta-analysis study was performed using the data of 181 studies indexed in the PubMed database showing that the mean platelet volume measurements varied up to 17.8 percent by the instruments and maximum deviation together with the difference of instruments used plus mean platelet volume measurement varying by up to 27.7 percent.4 The mean platelet volume measurements were not standardized in the retrospective study of Demir et al. Because the measurement times after sampling and the use of automated cell analyzers were not specified, the data were questionable. Finally, Noris et al. emphasized that mean platelet volume had no role in making a diagnosis and defining the prognosis in any acquired illness because of the wide range of mean platelet volume attributable to platelet count, sex, age, and ethnicity, and the poor standardization of the methodologies used for mean platelet volume measurement.5 As a result, mean platelet volume may not have a role in the prognosis of patients with Fournier gangrene.
DISCLOSURE
The authors have no financial interest thing to disclose. No funding was received for this communication.
Cengiz Beyan, M.D.
Department of Hematology
Ufuk University Faculty of Medicine
Esin Beyan, M.D.
Department of Internal Medicine
University of Health Sciences
Kecioren Training and Research Hospital
Ankara, Turkey
REFERENCES
1. Demir CY, Yuzkat N, Ozsular Y, Kocak OF, Soyalp C, Demirkiran H. Fournier gangrene: Association of mortality with the complete blood count parameters. Plast Reconstr Surg. 2018;142:68e–75e.
2. Beyan C, Kaptan K, Ifran A. Platelet count, mean platelet volume, platelet distribution width, and plateletcrit do not correlate with optical platelet aggregation responses in healthy volunteers. J Thromb Thrombolysis 2006;22:161–164.
3. Jackson SR, Carter JM. Platelet volume: Laboratory measurement and clinical application. Blood Rev. 1993;7:104–113.
4. Beyan C, Beyan E. Were the measurements standardized sufficiently in published studies about mean platelet volume? Blood Coagul Fibrinolysis 2017;28:234–236.
5. Noris P, Melazzini F, Balduini CL. New roles for mean platelet volume measurement in the clinical practice? Platelets 2016;27:607–612.
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