CBC Biomarkers: Mean Platelet Volume (MPV)

Optimal Takeaways

Mean platelet volume (MPV) is part of the complete blood cell count (CBC). The MPV reflects the average size, as well as the production and release, of platelets from the bone marrow. An increasing MPV indicates that production is accelerated but results in larger, immature, and more reactive platelets, increasing the risk of complications. A low MPV may be associated with aplastic anemia and chemotherapy treatment.

Standard Range: 7.5 - 11.5 fL

The ODX Range: 7.5 - 8.2 fL

Low MPV can be associated with aplastic anemia, chemotherapy, and Wiskott-Aldrich syndrome (Pagana 2022). Active rheumatoid arthritis and other conditions associated with high-grade inflammation are also associated with lower MPV (Gasparyan 2011).

High MPV is associated with thrombocytopenia, massive hemorrhage, myelogenous leukemia, valvular heart disease, and B12 or folate deficiency (Pagana 2022). An elevated level may also be associated with thrombosis, increased vascular risk, more severe ischemic stroke, myocardial infarction, diabetes, metabolic syndrome, hypercholesterolemia, renal artery stenosis (Elsayed 2017), chronic low-grade inflammation (Gasparyan 2011), deep vein thrombosis (Han 2013), and left ventricular hypertrophy (Anderson 2007).

Overview

Mean platelet volume is dependent on bone marrow production of platelets, the small blood cells that facilitate clotting. The MPV will be low, and platelets will be smaller when bone marrow production is inadequate. However, MPV will be high if the bone marrow is functional and is attempting to increase platelet production but releases larger immature platelets, e.g., in thrombocytopenia (Pagana 2022).

These larger platelets are more active and reactive, more aggregative, and produce more prothrombotic factors and thromboxane A2 which promotes vasoconstriction. An MPV greater than 8.1 fL increases the risk of ischemic stroke (Elsayed 2017). In patients with atrial fibrillation, an MPV of greater than 9.4 fL was associated with a significantly greater occurrence of stroke (Turfan 2013). An MPV cut-off of 9.25 was recommended for predicting acute MI in a case-control study of 128 subjects, while a cut-off of 9.15 was recommended for identifying stable coronary artery disease (Khode 2012). However, a tighter range would be more appropriate as an MPV of 8.5 fL was associated with mild CAD, and a level of 8.7 was associated with severe CAD, while controls maintained a level of 8.3 (Akboga 2015).

Elevated MPV may increase the risk of a number of chronic diseases. In hypertensive individuals, a higher mean platelet volume was linked to the risk of cardiovascular complications, including myocardial infarction, stroke, and left ventricular hypertrophy (Anderson 2007). A mean platelet volume above 8.2 fL is associated with a significantly greater risk of deep vein thrombosis (Han 2013). An MPV of 8.2 fL was associated with diabetes, with risk increasing most significantly with an MPV of 9.31 fL or greater (Shah 2012).

In one meta-analysis of 40 observational studies, an MPV of 7.3 fL or higher was associated with an increased risk of coronary artery disease, with a level of 7.7 fL or higher increasing risk by two-fold (Sansanayudh 2014). Further assessment of cardiac risk factors would be prudent with an MPV at this level.

Colorectal cancer patients with an MPV above 8.6 fL had increased tumor differentiation and a significantly worse prognosis than those with 8.6 fL or below (Li 2017).

References

Akboga, Mehmet Kadri et al. “Association of serum total bilirubin level with severity of coronary atherosclerosis is linked to systemic inflammation.” Atherosclerosis vol. 240,1 (2015): 110-4. doi:10.1016/j.atherosclerosis.2015.02.051

Anderson, Jeffrey L et al. “Usefulness of a complete blood count-derived risk score to predict incident mortality in patients with suspected cardiovascular disease.” The American journal of cardiology vol. 99,2 (2007): 169-74. doi:10.1016/j.amjcard.2006.08.015

Elsayed, Amira M., and Ghada A. Mohamed. "Mean platelet volume and mean platelet volume/platelet count ratio as a risk stratification tool in the assessment of severity of acute ischemic stroke." Alexandria journal of medicine 53.1 (2017): 67-70.

Gasparyan, Armen Yuri et al. “Mean platelet volume: a link between thrombosis and inflammation?.” Current pharmaceutical design vol. 17,1 (2011): 47-58. doi:10.2174/138161211795049804

Han, Jin Soo et al. “Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis.” Platelets vol. 24,8 (2013): 590-3. doi:10.3109/09537104.2012.748187

Khode, Vitthal et al. “Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study.” Journal of cardiovascular disease research vol. 3,4 (2012): 272-5. doi:10.4103/0975-3583.102694

Li, Na et al. “Elevated mean platelet volume predicts poor prognosis in colorectal cancer.” Scientific reports vol. 7,1 10261. 31 Aug. 2017, doi:10.1038/s41598-017-11053-y

Pagana, Kathleen Deska, et al. Mosby’s Diagnostic and Laboratory Test Reference. 16th ed., Mosby, 2022.

Sansanayudh, Nakarin et al. “Mean platelet volume and coronary artery disease: a systematic review and meta-analysis.” International journal of cardiology vol. 175,3 (2014): 433-40. doi:10.1016/j.ijcard.2014.06.028 [R]

Shah, Binita et al. “The relationship between diabetes, metabolic syndrome, and platelet activity as measured by mean platelet volume: the National Health And Nutrition Examination Survey, 1999-2004.” Diabetes care vol. 35,5 (2012): 1074-8. doi:10.2337/dc11-1724

Turfan, Murat et al. “Usefulness of mean platelet volume for predicting stroke risk in atrial fibrillation patients.” Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis vol. 24,1 (2013): 55-8. doi:10.1097/MBC.0b013e32835a0850