Original Article

Mean Platelet Volume as an Inflammatory

Marker in Chronic Sinusitis

Sema Koç, Ahmet Eyibilen, Ahmet Serhat Erdoğan

Gaziosmanpasa University, School of Medi- ABSTRACT

cine Department of Otorhinolaryngology,
Tokat, Turkey Aim: Chronic rhinosinusitis (CRS) is characterized by persistent inflam-
mation of the nasal and paranasal sinus mucosa. The pathogenesis of
Eur J Gen Med 2011;8(4):314-317 chronic sinusitis is not yet clearly understood. Recently, mean plate-
Received: 13.10.2011 let volume (MPV) has been known as a simple inflammatory marker in
inflammatory diseases. The aim of this study was to investigate the
Accepted: 14.12.2011
levels of hematological parameters such as red blood cells (RBC), hae-
moglobine (Hb), haematocrit (Htc), white blood cells (WBC), platelet
(PLT), and mean platelet volume (MPV) in patients with CRS without
nasal polyposis.
Method: After overnight fasting, peripheral venous blood samples
were taken from patients with CRS and control groups. We measured
the complete blood count (CBC) parameters in a blood sample col-
lected in etilendiamintetraasetik asit (EDTA). Laboratory data were
screened via hospital’s computerised database.
Result: CRS group consisted a total of 90 patients, 34 (38%) male and
control group consisted 90 patients, 44 (49%) male. WBC, RBC, Hb and
Htc levels were similar in patient and control groups. However, PLT
level was borderline higher in CRS group compared to control group
(284±87 vs 253±59, P=0.06) and MPV level was significantly higher in
CRS group compared to control group (8.0±0.9 vs 7.3±0.9, P<0.001).
Conclusion: As CRS is a chronic inflammatory disorder, we believe
that platelets have a role in CRS. If MPV value is an indicator of in-
flammation, increased MPV values may be associated with CRS.
Key words: Chronic rhinosinusitis, platelet, mean platelet volume

Correspondence: Sema Koc, MD

Gaziosmanpasa University School of Medi-
cine Department of Otorhinolaryngology,
Tokat/Turkey
Tel: +905054983511
E-mail: [email protected]

European Journal of General Medicine

Mean platelet volume as inflammatory marker in sinusitis

Kronik Sinüzitte Antiinflamtuar Olarak Ortalama Trombosit Hacmi

Amaç: Kronik rinosinuzit paranazal sinüs ve nazal mukozanın kronik inflamasyonuyla karakterize bir hastalıktır. Kronik rino-
sinuzitin etyopatogenezi henüz tam olarak bilinmemektedir. Özellikle son zamanlarda kronik inflamasyonda plateletlerin önemli
fonksiyonları olduğu ve mean platelet volume (MPV)’ün bazı inflamatuar hastalıklarda inflamatuar belirteç olarak kullanılabileceği
bildirilmiştir. Bu çalışmanın amacı kronik rinosinuzit hastalarında eritrosit, hemoglobin, hemotokrit, lökosit, platelet ve MPV gibi
hematolojik parametreleri araştırmaktır.
Metod: Kronik rinosinuzit hastaları ve sağlıklı kontrol grubundan 12 saat açlık sonrası etilendiamintetraasetik asit (EDTA)’li tü-
plere kan alındı. Alınan kanlarda tam kan sayımı yapıldı. Hasta ve kontrol grubunun verileri kaydedildi.
Bulgular: Çalışmaya 90 kronik rinosinuzit hastası (34 (% 38) erkek, 56 (% 62) kadın) ve 90 kontrol grubu (44 (% 49) erkek, 46 (%51)
kadın) dahil edildi. Lökosit, eritrosit, hemoglobin ve hemotokrit değerleri kronik rinosinuzit grubu ve kontrol grubunda benzer
idi. Fakat platelet düzeyi kronik rinosinuzit grubunda kontrol grubuna göre sınırda yüksek idi (284±87 vs 253±59, P=0.06) ve MPV
düzeyi kronik rinosinuzit grubunda kontrol grubuna göre belirgin yüksek idi (8.0±0.9 vs 7.3±0.9, P<0.001).
Sonuç: Kronik inflamatuar bir hastalık olan kronik rinosinuzit etyopatogenezinde plateletlerin rolü olabilir ve kronik rinosinuzitte
düzeyi artan MPV inflamasyonun bir belirteci olabilir.
Anahtar kelimeler: Kronik rinosinüzit, trombosit, ortalama trombosit hacmi

INTRODUCTION MATERIALS AND METHODS

Chronic rhinosinusitis (CRS) is a prevalent health condi- Patients with CRS all had symptoms of nasal obstruction,
tion, causing significant morbidity and resulting in great headache, and nasal discharge for more than 3 months.
financial cost. CRS is characterized by sinonasal mucosal The diagnosis of CRS was supported by the clinical histo-
inflammation lasting more than 12 weeks (1). Patients ry, endoscopic examination, and computed tomographic
may experience nasal obstruction, smell loss, a sensation scan of the paranasal sinuses, which showed opacifi-
of facial or forehead heaviness, rhinorrhea and headache. cation of the paranasal sinuses. Patients with chronic
The pathogenesis of chronic sinusitis is not yet clearly un- underlying diseases (including cardiovascular disorders,
derstood. There are studies reporting that deterioration malignancy, asthma, cystic fibrosis, metabolic disease,
of normal epithelial function as a result of inflammation renal or liver disease or gross immunodeficiency) were
can cause mucostasis and microbial colonization (2). excluded from study. The controls were healthy volun-
teers. None of the controls had suffered from sinusitis,
Inflammation stimulates platelets. Although platelets are
rhinitis, or chronic illnesses during the previous year.
primarily known for pivotal role in hemostasis, in recent
Blood samples were drawn after a fasting period of 12
years it has been shown that platelets can act as inflam-
h from patients with CRS and control groups. We mea-
matory cells by undergoing chemotaxis, releasing vari-
sured the complete blood count (CBC) parameters in a
ous chemokines ve cytokines. Large platelets have more
blood sample collected in etilendiamintetraasetik asit
granules, and so inflammatory cytokine and chemokine
(EDTA). Laboratory data were screened via hospital’s
releases are more prominent (4). Mean platelet volume
computerised database. The reference values for MPV
(MPV) is readily measured by clinical hematology analyz-
ranged between 7.0 and 11.0 fL and for platelet 150-400
ers and is an indicator of platelet activation. An increase
103 /μL.
in platelet size as a result of platelet activation has been
shown to be associated with numerous inflammatory dis-
ease (5-9).
RESULTS
To the best of our knowledge, there is no study evaluat-
Chronic rhinosinusitis group consisted a total of 90 pa-
ing the relationship between CRS and MPV. The aim of
tients, 34 (38%) male and control group consisted 90
this study was to investigate the levels of hematological
patients, 44 (49%) male. There were no significant dif-
parameters such as red blood cells (RBC), haemoglobine
ferences between patientsand control groups in terms
(Hb), haematocrit (Htc), white blood cells (WBC), plate-
of age and gender. As seen in Table 1, WBC, RBC, Hb and
let (PLT), and MPV in patients with CRS without nasal pol-
Htc levels were similar in patient and control groups.
yposis.
However, PLT level was borderline higher in CRS group
compared to control group (284±87 vs 253±59, p=0.06)

315 Eur J Gen Med 2011;8(4):314-317

 Koç et al.

Table 1. Study parameters in chronic sinusitis and phagocytosis of microorganisms like bacteria, virus and
control groups parasites; vascular permeability increase in the inflam-
Chronic sinusitis Control p value mation; and PLTs have important roles in the secretions
WBC (/μL) 7000±1700 7000±2000 ns of some inflammatory cytokines (14). When PLTs are ac-
RBC (106/μL) 4.7±0.5 4.6±0.5 ns tivated, they have changes in their shapes and sizes. PLT
Hb (g/dL) 13.2±1.5 13.3±1.3 ns
Htc (%) 40±4 41±6 ns
function and size correlate because larger PLTs contain
PLT (103/μL) 284±87 253±59 ns more granules and and are metabolically and enzymati-
MPV (fL) 8.0±0.9 7.3±0.9 <0.001 cally more active (15). MPV which is a machine-calculat-
Age, y 42±13 44±16 ns
Male, n (%) 34 (38) 44 (49) ns
ed measurement of the average size of platelets is as-
Values are presented as mean±SD,
sociated with platelet activation. Increased MPV levels
WBC, white blood cells; RBC, red blood cells; Hb, haemoglobine; Htc, haematocrit; have been associated with Crohn’s disease, rheumatoid
PLT, platelet; MPV, mean platelet volume
arthritis, familial Mediterranean fever, ulcerative coli-
tis, acute pancreatitis, acute ischemic stroke, diabe-
tes and myocardial infarction. Recently, MPV has been
known as a simple inflammatory marker in inflammatory
and MPV level was significantly higher in CRS group com- diseases (5-10).
pared to control group (8.0±0.9 vs 7.3±0.9, p<0.001).
Yazıcı et al. (16) found significantly higher baseline MPV,
PLT and platelet mass (PLM) values in ankylosing spon-
DISCUSSION dylitis subjects than in controls, and both inflammatory
markers and platelet function parameters were mark-
In this study, the values of WBC, RBC, Hb and Htc levels edly reduced by the anti-TNF-alpha therapy. Gasparyan
were similar in patient and control groups. However, PLT et al. (17) evaluated retrospectively the laboratory
level was borderline higher in CRS group compared to parameters, including MPV and PLT, in 400 rheumatoid
control group and MPV level was significantly higher in arthritis, an inflammator disease, patients and in 360
CRS group compared to control group. healthy controls. They reported that platelet count and
The pathogenesis of CRS is less well understood and is MPV levels were higher in rheumatoid arthritis patients
believed to be multifactorial. Multiple inflammatory, in- than those in the control group. Tozkoparan et al. (14)
fectious, host or structural factors, biofilms, and supe- reported that MPV values were higher in patiets with
rantigens variably contribute to trigger and sustain the tuberculosis than the control group. They also reported
persistent inflammation in CRS. In a few cases of CRS, that MPV levels could be an additional inflammatory
important underlying conditions cause the pathogen- marker in tuberculosis therapy concomitant with labo-
esis, such as sinonasal anatomic anomalies, cystic fibro- ratory, radiographic and clinical findings. Karabudak et
sis, primary ciliary dyskinesia. However, the majority of al. (18) found that levels of inflammation markers, such
cases of CRS are currently considered to be idiopathic as MPV, C-reactive protein and ceruloplasmin were high-
(11). CRS is characterized by persistent inflammation er then those in the controls in another inflammatory
of the nasal and paranasal sinus mucosa. CRS without disease, namely psoriasis.
nasal polyps represented a predominant neutrophilic The results of our study were similar to those of the stud-
inflammation and TH1 milieu in the stroma (12). While ies given above. In our trial, MPV level was significantly
factors affecting the chronic inflammation and edema higher in CRS group compared to control group and PLT
development in CRS are not clearly revealed, cytokines level was borderline higher in CRS group compared to
like IL-1α, IL-1β, IL-6, interferon-α, TNF, and IL-8 have control group. As CRS is a chronic inflammatory disorder,
been reported to have important roles in the inflamma- we believe that platelets have a role in CRS. If MPV val-
tory response (13). ue is an indicator of inflammation, increased MPV values
Platelets are known for a long time to have important may be associated with CRS. Further prospective studies
roles in hemostasis. There are various studies, which are needed to establish the role of platelets in CRS and
have reported that immune cells like polymorphonu- pathophysiology its clinical significance.
clear leukocytes have important roles in chemotaxis;

Eur J Gen Med 2011;8(4):314-317 316

Mean platelet volume as inflammatory marker in sinusitis

REFERENCES 11. Fokkens W, Lund V, Mullol J. EPOS 2007: European posi-

tion paper on rhinosinusitis and nasal polyps. Rhinology
1. Wood AJ, Douglas RG. Pathogenesis and treatment of 2007;45:1-139.
chronic rhinosinusitis. Postgrad Med J 2010;86:359-64.
12. Cao PP, Li HB, Wang BF, et al. Distinct immunopathologic
2. Lee S, Lane AP. Chronic rhinosinusitis as a multifactorial characteristics of various types of chronic rhinosinusitis
inflammatory disorder. Curr Infect Dis Rep 2011;13:159- in adult Chinese. J Allergy Clin Immunol 2009;124:478-84.
68.
13. Yoon BN, Choi NG, Lee HS, Cho KS, Roh HJ. Induction
3. Herd CM, Page CP. Pulmonary immune cells in health and of interleukin-8 from nasal epithelial cells during bac-
disease: platelets. Eur Respir J 1994;7:1145-60. terial infection: the role of IL-8 for neutrophil recruit-
4. Bath PM, Butterworth RJ. Platelet size: measurement, ment in chronic rhinosinusitis. Mediators Inflamm
physiology and vascular disease. Blood Coagul Fibrinolysis 2010;2010:813610. Epub 2010 Jun 20.
1996;7:157-61. 14. Tozkoparan E, Deniz O, Ucar E, Bilgic H, Ekiz K. Changes in
5. Yuksel O, Helvaci K, Basar O, et al. An overlooked indica- platelet count and indices in pulmonary tuberculosis. Clin
tor of disease activity in ulcerative colitis: mean platelet Chem Lab Med 2007;45:1009-13.
volume. Platelets 2009;20:277-81. 15. Vizioli L, Muscari S, Muscari A. The relationship of mean
6. Endler G, Klimesch A, Sunder-Plassmann H, et al. Mean platelet volume with the risk and prognosis of cardiovas-
platelet volume is an independent risk factor for myocar- cular diseases. Int J Clin Pract 2009;63:1509-15.
dial infarction but not for coronary artery disease. Br J 16. Yazici S, Yazici M, Erer B, et al. The platelet functions
Haematol 2002;117:399-404. in patients with ankylosing spondylitis: anti-TNF-alpha
7. Mimidis K, Papadopoulos V, Kotsianidis J, et al. Alterations therapy decreases the mean platelet volume and platelet
of platelet function, number and indexes during acute mass. Platelets 2010;21:126-31.
pancreatitis. Pancreatology 2004;4:22-7. 17. Gasparyan AY, Stavropoulos-Kalinoglou A, Toms TE,
8. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet Douglas KM, Kitas GD. Association of mean platelet vol-
volume (MPV) as an inflammatory marker in ankylosing ume with hypertension in rheumatoid arthritis. Inflamm
spondylitis and rheumatoid arthritis. Joint Bone Spine Allergy Drug Targets 2010;9:45-50.
2008;75:291-4. 18. Karabudak O, Ulusoy RE, Erikci AA, Solmazgul E, Dogan B,
9. Tuncel T, Uysal P, Hocaoglu AB, Erge DO, Karaman O, Harmanyeri Y. Inflammation and hypercoagulable state in
Uzuner N. Change of mean platelet volume values in adult psoriatic men. Acta Derm Venereol 2008;88:337-40.
asthmatic children as an inflammatory marker. Allergol
Immunopathol (Madr). 2011 May 26. [Epub ahead of print]
10. Eloy P, Poirrier AL, De Dorlodot C, Van Zele T, Watelet
JB, Bertrand B. Actual concepts in rhinosinusitis: a review
of clinical presentations, inflammatory pathways, cyto-
kine profiles, remodeling, and management. Curr Allergy
Asthma Rep 2011;11:146-62.

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