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Rhinological and Otological Society, Inc.
Relation of Mean Platelet Volume and Red Blood Cell Distribution
Width With Epistaxis
Ozgur Kemal, MD; Togay M€
uderris, MD; Erg€
un Sevil, MD; G€okhan Kutlar, MD
Objectives/Hypothesis: Mean platelet volume is the measurement of the average size of platelets in the blood, and red
blood cell distribution width is the variability of the size of red blood cells in circulation. This study aimed to investigate if
there was any relationship between mean platelet volume, red blood cell distribution, and epistaxis.
Study Design: Prospective controlled trial.
Methods: The study included 90 patients admitted to Ankara Atat€
urk Hospital and Samsun Medicana Hospital with
complaints of recurrent epistaxis, and a control group of 90 healthy subjects. Blood samples were taken from all patients and
control group subjects. Mean platelet volume and red blood cell distribution parameters were examined and compared
between the two groups.
Results: The mean platelet volume levels were determined as 8.86 6 0.1 in the control group and 8.36 6 0.1 in the
patient group. The difference between the two groups with respect to mean platelet volume was statistically significant
(P <.05). The mean red blood cell distribution levels were determined as 12.68 6 0.32 in the control group and 11.90 6 0.16
in the patient group. The difference between the two groups with respect to red blood cell distribution was also statistically
significant (P <.05).
Conclusions: The results of this study showed a clinical finding of lower mean platelet volume and red blood cell distribution levels in epistaxis. These findings could be beneficial in new investigations into epistaxis mechanisms.
Key Words: Mean platelet volume, red blood cell distribution, epistaxis.
Level of Evidence: 3b.
Laryngoscope, 125:788–790, 2015
INTRODUCTION
Epistaxis (derived from the Greek word epistazo, to
bleed from the nose), is a common emergency in otorhinolaryngology, as 60% of the entire population experience epistaxis at least once in their lifetime.1 It has a
greater prevalence in those under the age of 10 years
and over 35 years. Within this group, 6% of patients
require emergency medical attention.2 Thus, 3% to 4% of
the population needs medical attention for epistaxis during their lifetime. In the majority of cases, the cause of
epistaxis is unknown, although localized conditions of
the nose and systemic conditions have been identified.3
Many conditions, such as the prevailing weather
and oral medications, have been discussed to determine
the risk factors of epistaxis.4,5 However, none can be considered as a single risk factor.
From the Otolaryngology Department (O.K., G.K.), Faculty of Medicine, Ondokuz Mayis University, Samsun; and the Otolaryngology
urk Education and Research HospiDepartment (T.M., E.S.), Ankara Atat€
tal, Ankara, Turkey.
Editor’s Note: This Manuscript was accepted for publication
September 30, 2014.
This is a multicentric study performed at Samsun Medicana Hospital and Ankara Atat€
urk Education and Research Hospital.
The authors have no funding, financial relationships, or conflicts
of interest to disclose.
Send correspondence to Ozgur Kemal, MD, Yesildere mah, Alaçam
cad, Mimoza evleri c blok 75/41, 55200 Atakum, Samsun, Turkey.
E-mail: [email protected]
DOI: 10.1002/lary.24990
Laryngoscope 125: April 2015
788
Platelets are disc-shaped cells, responsible for coagulation of the blood. Their main role is to maintain the
integrity of blood vessels for adequate hemostasis. Their
count varies over a considerable range of 150,000 to
400,000/mm3. Platelets may differ in size and hemostatic
potential.6 Mean platelet volume (MPV) is a a measurement of the average size of platelets in the blood.7 Platelets secrete and express a large number of substances
that are crucial mediators of coagulation. Larger platelets may contain more granules and produce greater
amounts of vasoactive and thrombotic factors, which
means greater hemostatic efficiency. Therefore, it is
clear that bigger platelets mean better hemostasis.8 Furthermore, higher MPV is observed in patients with diabetes mellitus, hypertension, hypercholesterolemia,
smoking, and obesity.9–13
Red blood cell distribution width (RDW) is the variability of the size of the red blood cells in circulation. It is
a routine component of the full blood count and is generally used in the diagnosis of hematological disorders,
especially the differential diagnosis of anemia. Several
studies have also shown a relationship between RDW and
cardiovascular diseases, strokes, pulmonary hypertension,
and peripheral arterial disease.14–19 The aim of this study
was to investigate the effect of MPV on epistaxis rates.
MATERIALS AND METHODS
Approval for the study was granted by the ethics committee of Ankara Yildirim Beyazit University. This prospective
study was conducted at Ankara Atat€
urk Hospital and Samsun
Kemal et al.: Relation of MPV and RDW With Epistaxis
RESULTS
TABLE I.
Descriptive Statistics of RDW and MPV.
RDW
Epistaxis
Control
MPV
Epistaxis
Statistic
SE
Mean
11.8978
0.15889
Median
SD
11.7000
1.50736
Minimum
9.10
Maximum
Mean
15.00
12.6858
Median
12.3000
SD
Minimum
3.30781
9.10
Maximum
34.90
Mean
Median
8.3578
8.4000
SD
0.93412
Minimum
Maximum
Control
0.32128
0.09846
DISCUSSION
6.00
10.30
Mean
8.8613
Median
SD
8.7000
1.03386
Minimum
6.90
Maximum
12.30
The mean age of the patients was 25.42 6 1.93 years,
and the mean age of the control group was 32.05 6 1.22
years. Of the 90 patients in the study group, 48 were
males (53.3%) and 42 (46.7%) were females. Of the 90 subjects in the control group, 56 (62.2%) were males and 34
(37.8%) were females (Tables I and II).
The mean MPV level was determined as 8.86 6 0.1
in the control group and 8.36 6 0.1 in the patient group.
The difference in MPV between the two groups was statistically significant (P <.05). The mean RDW level was
determined as 12.68 6 0.32 in the control group and
11.90 6 0.16 in the patient group. The difference in RDW
between the two groups was also statistically significant
(P <.05) (Table III).
0.10042
MPV 5 mean platelet volume; RDW 5 red blood cell distribution
width; SD 5 standard deviation; SE 5 standard error.
Medicana Hospital between April 2013 and April 2014. A total
of 90 patients admitted to the two centers with complaints of
recurrent epistaxis were included, and a control group was
formed of 90 healthy subjects. Healthy subjects were selected
from the checkup clinics of hospitals, and before including them
in the study they were physically examined and blood tests
were taken. After the tests they were considered healthy subjects. Informed consent was obtained from all study participants. All patients underwent a detailed physical examination,
and those with bleeding disorders, chronic diseases, acute infection, or a history of hypertension were excluded.
Blood samples were taken from all patients and control
group subjects. MPV and RDW parameters were examined and
compared between the two groups. In our laboratory, the normal value for MPV ranges between 6 and 11 mm3, and for RDW,
the normal range is 7% to 16%.
Statistical analyses were performed with SPSS software
(SPSS 15.0, SPSS, Inc., Chicago, IL). All parameters were
expressed as mean 6 standard deviation. The normality of distribution was checked initially by the Shapiro-Wilk test; the
Mann-Whitney U test was used to compare the parameters
between the epistaxis and control subjects. The results were
expressed as mean 6 standard deviation. A value of P <.05 was
considered statistically significant.
To the best of our knowledge, this is the first study
to show an association between RDW and MPV values
and epistaxis. The results of this study showed that the
MPV and RDW levels of the epistaxis patients were
lower than those of the healthy control group, and the
differences were statistically significant.
Epistaxis is a common bleeding event that may be a
symptom of a coagulopathy. Sandoval et al. showed that
children with recurrent epistaxis have more severe coagulopathy than healthy children. In a study of 178 children with recurrent epistaxis, 33% coagulopathy was
determined, the most common of which was von Willebrand’s disease (56%).20 It is also clear that coagulation
problems are not the only reason for epistaxis, as there
may be different reasons such as weather conditions or
septum deviation.4,21 RDW and MPV have not been considered as a reason of epistaxis.
MPV is a simple way to assess platelet function.22,23
Platelets are formed via cytoplasmic fragmentation of
bone marrow–derived megakaryocytes. They are heterogeneous in size, density, and reactivity, with granules
responsible for aggregation. In comparison to small platelets, large platelets have more granules, which means
aggregation will be more rapid with collagen, have a
higher tromboxane A2 level, and more glycoprotein Ib
and IIa/IIIa receptors will be expressed.24–26 Many studies have investigated the relationship between MPV and
thrombotic disorders such as coronary artery disease,
risk of coronary stent restenosis, peripheral artery disease, diabetes mellitus, and metabolic syndrome.8,27
A normal RDW range means that the red cells have
a normal distribution pattern. Increased RDW, known as
TABLE III.
Comparison of the Parameters of MPV and RDW.
TABLE II.
Age and Gender of Patients and Control Subjects.
Patients
Controls
90
90
25.42 6 1.93
32.05 6 1.22
42/48
34/56
No. of patients
Age (mean 6 SD)
Patients
Gender (female/male)
Laryngoscope 125: April 2015
Controls
P Value
MPV
8.36 6 0.98
8.86 6 0.10
.005
RDW
11.90 6 0.16
12.69 6 0.32
.040
The Mann-Whitney U test was used in the comparison. MPV and
RDW are both statistically significant.
MPV 5 mean platelet volume; RDW 5 red blood cell distribution
width.
Kemal et al.: Relation of MPV and RDW With Epistaxis
789
anisocytosis, indicates increased variability of red blood
cell size. Elevated RDW is commonly found in iron deficiency, folate deficiency, vitamin B12 deficiency, or after
transfusion.28 Several studies have shown a relationship
between RDW and cardiovascular events. Lappe et al.
reported an association of RDW with mortality in
patients with angina pectoris; therefore, RDW can be a
prognostic factor for peripheral arterial disease.19,29
It has been shown that both RDW and MPV levels
are higher in patients who experience thrombotic events
such as atherosclerosis or cerebrovascular events. In the
current study, these levels were found to be lower in
epistaxis patients. Higher MPV levels are associated
with low rates of epistaxis. The mechanisms responsible
are not clearly elucidated, but high MPV levels are
known to be associated with more thrombosis. The probable mechanism of lower epistaxis rates with high MPV
levels is the better hemostasis of large platelets. The
relationship between RDW and epistaxis is not clear, but
the increase in RDW may be a result of recurrent epistaxis, as recurrent bleeding events may increase erythropoietic activity and thereby result in increased RDW.
The current study is a clinical study, and the mechanism
of the relationship between MPV, RDW, and epistaxis is
still not fully understood. Pathophysiological mechanisms can only be speculative, and further studies are
required to investigate and clarify the mechanisms. It is
possible that a higher level of RDW and MPV plays a
role in thrombosis and may play a role in the hemostasis
of epistaxis patients. Also MPV and RDW levels may be
a prognostic factor after the consensus of further studies. At the present time, it is not possible to resize the
platelets or correct the RDW levels for the treatment of
epistaxis. But it may be possible in the future, and that
possibility may play a role in the treatment of epistaxis.
CONCLUSION
The results of this study have shown a clinical finding
of lower MPV and RDW levels in recurrent epistaxis
patients. However, the pathophysiological mechanism of the
relationship requires further studies for full clarification.
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Kemal et al.: Relation of MPV and RDW With Epistaxis