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ORIGINAL ARTICLE
Introduction
Platelets are small (1-4 m in diameter), discoid, nonnucleated structures, arising from the fragmentation of
megakaryocytes. Platelets,besides being acute phase
reactants, are also influenced by the patient,s health and
nutritional status (1). Upto 65% of platelets are smooth,
disc shaped cells(discocytes),whereas the remaining 1035% are less clearly defined cells(spherical platelets). A
morphological consideration of platelets has important
implications for both interpreting the functional
expressions of platelets and experimental measurement
of platelet size (2).Counter flow centrifugation can be
used to separate platelets into fractions by differences in
platelet volume. These differences in platelet volume
correlate with differences in density, dense body content,
enzymatic activity of LDH (lactate dehydrogenase),
platelet aggregation to ADP(adenosine diphospate), and
serotonin uptake and release, supporting the relevance
of the mean platelet volume (MPV) as a measure of
platelet functional capability (3).Platelet size (MPV), a
marker (and possibly a determinant) of platelet function
is a physiological variable of haemostatic importance (4).
Large platelets are metabolically more reactive, produce
more prothrombotic factors and aggregate more easily
(5,6,7). They also contain more dense granules and release
more serotonin and beta thromboglobulin than do small
platelets (8). Mean platelet volume, as well as platelet
count, are an index of haemostasis and its dysfunction
i.e. thrombosis. Changes in MPV play a more important
From the Deptt. of Medicine (Neurology),Govt. Medical College & Associated SMHS hospital,Srinagar (J&K).190010-India
Correspondence to : Dr. Parvaiz A. Shah. Consultant Neurologist, H.NO:35,Momin-Abad,Hyderpora Bye-pass(East), Srinagar, (J&K)-India
136
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disease (26). Our aim was to study the possible role of
platelet morphology in general and mean platelet volume
(MPV) in particular in pathogenesis of Ischemic Stroke
and role of mean platelet volume, if any, in the severity
and outcome of Ischemic stroke.
Material & Methods
The present prospective case control study was
conducted on 100 consecutive ischemic stroke patients
admitted to various medical wards of SMHS hospital (an
associated teaching hospital of Govt. Medical College,
Srinagar). The diagnosis of stroke was entertained after
fulfilling WHO definition of stroke by the patient (27).
The ischemic nature of stroke was established by
noncontrast cranial computed tomographic scan and the
severity of stroke assessed by modified Rankin Scale(mRS) (28). Patients with an mRS score of 0-2 and 3-6 at
the end of first week were classified as independent and
dependent/dead respectively. Patients with haemorrhagic
stroke,comorbid medical illnessess likely to interfere with
platelet function/ morphology and those receiving
medication likely to interefere with platelet morphology
or function were excluded from the study. Each patient
after detailed history and physical examination was
subjected to various baseline haematological and
biochemical investigations.All patients were subjected to
Carotid Doppler, echocardiography, chest x-ray and
electrocardiography . Control group comprised of age
and sex-matched 100 subjects with no clinical evidence
of any active vascular disease, previous cerebrovascular
disease, malignancy or infarction and not taking
medications known to affect platelet function. Control
group included attendants of patients who were enrolled
in the study after written consent.After all aseptic
precautions 2ml of blood sample was obtained from
antecubital vein of the patient within 48 hours of onset of
S. No.
1
2
3
4
5
6
7
8
9
10
Parameter
MPV (fl)
9
PC x 10 /L{Platelet coun t}
PDW (fl)
PLCR %
Hb g/dl
Hct %
MCV (fl)
12
Range
7 .8 15.2
1 24
12.3
24.7
11.6
31.4
276
23.7
48.9
18.3
61.3
73.3 104.8
2 43 984
324 1283
3 65
MeanSD
11.86 + 0.96
168 + 29
17.11 + 3.4
37.4 + 5.8
14.8 + 1.9
43.7 + 2.8
87.2 + 6.3
447 + 44
383 + 47
26.3 + 3.1
MPV=Mean platelet volume, PDW= Platelet Distribution Width , PLCR= Platelet crit Hb=Haemoglobin , MCV=Mean Corpuscular
Volume RBC=Red Blood Cell WBC=White Blood Cell , ESR =Erythrocyte Sedimentation Rate, PC=Platelet count, Hct=Haematocrit
Vol. 15 No. 3, July-September 2013
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Table. 2 Relationship of MPV With Mrs-Score on Admission & at Week
Outcome (mRS-Score)
MPV (fl)
7.8 9.0
9.1 9.8
9.9 10.6
10.7 11.4
11.5 15.2
TOTAL
On Admission
0 2
36
10 (16.12)
8 (21.05)
8 (12.90)
9 (23.68)
16 (25.80)
7 (18.42)
15 (24.19)
6 (15.78)
13 (20.96)
8 (21.05)
62 (100)
38 (100)
At One Week
0 2
3 6
12 (21.05)
6 (13.95)
9 (15.78)
8 (18.60)
14 (24.57)
9 (20.93)
12 (21.05)
9 (20.93)
10 (17.54)
11 (25.58)
57 (100)
43 (100)
P-Value
< 0.05
Significant
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(mRS Score) of 0-2, 3-5 and 6 was found in 57%, 39%
and 4% cases respectively. Age and sex had no statistically
significant impact on mRS score. Patients with higher MPV
had worse outcome at the end of one week. This fact is
corroborated by other studies as well (24,25,26,37).
Moreover, there was no statistically significant relationship
between stroke-subtype and outcome at the end of one
week. Again, this observation is substantiated by other
workers (39).Thus, mean platelet volume bears an inverse
relationship to immediate outcome from ischemic stroke
independent of stroke subtype.
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