Platelets are essential for progression of atherosclerotic lesions, plaque destabilization, and thrombosis. They secrete and express many substances that are crucial mediators of coagulation, inflammation, and atherosclerosis. Mean platelet volume (MPV) is a precise measure of platelet size, and is routinely reported during complete blood count analysis. Emerging evidence supports the use of MPV as a biomarker predicting the risk of ischemic stroke in patients with atrial fibrillation, and as a guide for prescription of anticoagulation and rhythm-control therapy. In addition, MPV may predict the clinical outcome of percutaneous coronary intervention (PCI) in patients with coronary artery disease and indicate whether additional adjunctive therapy is needed to improve clinical outcomes. This review focuses on the current evidence that MPV may be a biomarker of the risk and prognosis of common heart diseases, particularly atrial fibrillation and coronary artery disease treated via PCI.

/pdf/mean-platelet-volume-a-potential-biomarker-of-the-risk-and-2nijaxmzr4.pdf

Mean platelet volume: a potential biomarker of the risk and prognosis of heart disease.

Mean platelet volume has been associated with stroke in patients with atrial fibrillation. However, its role as a predictor of left atrial stasis, assessed by transesophageal echocardiography, in patients with non-valvular atrial fibrillation has not yet been clarified. Single center cross-sectional study comprising 427 patients admitted to the emergency department due to symptomatic atrial fibrillation and undergoing transesophageal echocardiogram evaluation for exclusion of left atrial appendage thrombus before cardioversion. All patients had a complete blood count performed in the 12 hours prior to transesophageal echocardiogram. Markers of left atrial stasis were sought: left atrial appendage thrombus, dense spontaneous echocardiographic contrast and low flow velocities in the left atrial appendage. The presence of at least one of the former markers of left atrial stasis was designated left atrial abnormality. Binary logistic multivariate analysis was used for obtaining models for the prediction of transesophageal echocardiogram endpoints. Left atrial appendage thrombus was found in 12.2%, dense spontaneous echocardiographic contrast in 29.7%, low flow velocities in 15.3% and left atrial abnormality in 34.2%. Mean platelet volume (exp β = 3.41 p = 0.048) alongside with previous stroke or transient ischemic attack (exp β = 5.35 p = 0.005) and troponin I (exp β = 5.07 p = 0.041) were independent predictors of left atrial appendage thrombus. Mean platelet volume was also incorporated in the predictive models of dense spontaneous echocardiographic contrast, low flow velocities and left atrial abnormality, adding predictive value to clinical, echocardiographic and laboratory variables. These findings suggest that mean platelet volume may be associated with the presence of markers of left atrial stasis, reinforcing a likely cardioembolic mechanism for its association with stroke in patients with non-valvular atrial fibrillation.

/pdf/mean-platelet-volume-is-associated-with-the-presence-of-left-2h034s2o35.pdf

Mean platelet volume is associated with the presence of left atrial stasis in patients with non-valvular atrial fibrillation

Mean platelet volume (MPV), a marker of platelet activation, is a surrogate marker of platelet function and a potential mediator of the association between inflammation and thrombosis. The present retrospective study sought to investigate the association between MPV and the presence of thrombotic events (TEs) in patients with chronic atrial fibrillation (AF). A total of 114 consecutive patients with chronic AF were enrolled from a Chinese hospital. Individuals were divided into three groups: The AF+TE group (n=57, 33.1%), which comprised patients in AF with concomitant TEs; the AF group (n=57, 33.1%), which comprised patients in AF with no identifiable TEs, as confirmed by brain computed tomography, transesophageal echocardiography, or a combination of the two; and a control group (n=58, 33.7%), which consisted of patients who were in sinus rhythm. MPV, high-sensitivity C-reactive protein (hsCRP), D-dimer and the left atrial diameter (LAD) were analyzed in the 172 participants. The MPV level of patients in the AF+TE group was significantly higher than that of patients in the AF and control groups (P 10.5 fl) was significantly associated with the occurrence of TEs (odds ratio, 3:1; 95% confidence interval, 1.6–5.1; P=0.000). The results of the present study suggest that an additional biomarker, MPV, has a predictive value for the presence of TEs in patients with AF. MPV may be a potential mediator between inflammation and thrombosis.

/pdf/the-association-between-mean-platelet-volume-and-chronic-16kb9vquy7.pdf

The association between mean platelet volume and chronic atrial fibrillation and the presence of thrombotic events

Cardiac troponin is widely used for the diagnosis of acute myocardial infarction. In addition to this indication, the elevation of troponin has been found to play a prognostic role in ischemic stroke. It is hypothesized that approximately 15–20 % of all ischemic strokes are associated with atrial fibrillation and that these events are more often fatal. Recent studies have demonstrated that troponin elevation can also be used as a prognosticator in patients with atrial fibrillation and for risk stratification to predict which patients are more prone to stroke or other thromboembolic events. Therefore, troponin appears to play a pivotal role in the overlap of atrial fibrillation and ischemic stroke and the subsequent development of an adverse outcome. The different aspects of this association will be addressed and novel explanations will be proposed to better clarify the underlying mechanisms.

Atrial fibrillation, elevated troponin, ischemic stroke and adverse outcomes: understanding the connection.

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 Ataturk 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 ± 0.1 in the control group and 8.36 ± 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 ± 0.32 in the control group and 11.90 ± 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.



Level of Evidence

3b. Laryngoscope, 125:788–790, 2015

Relation of mean platelet volume and red blood cell distribution width with epistaxis

Early detection of atrial fibrillation patients at high risk for stroke is important. There are some studies which indicate that mean platelet volume (MPV) determines the prognosis and risk in patients with a stroke. In this study, our aim was to investigate the association between the MPV measured in stroke patients with atrial fibrillation. Consecutive patients referred to our center between January 2010 and April 2012 were included in this study. The patients with atrial fibrillation were classified into two groups according to presence or absence of a history of stroke by combining data from the medical histories after a thorough review of the medical records. MPV determination was made within 24 h following the onset of stroke. We studied 63 consecutive stroke patients with atrial fibrillation and 77 atrial fibrillation patients without stroke history. In receiver-operating characteristic (ROC) curve analysis, the value for MPV levels to detect stroke with a sensitivity of 63.5% and specificity of 64.4% was 9.4 fl. High MPV (>9.4 fl) was significantly associated with the occurrence of stroke [odds ratio (OR) 4.021, 95% confidence interval (CI) 1709-9464, P < 0.001]. Our study supports the hypothesis that a high MPV is associated with an increased risk of stroke in atrial fibrillation patients.

Usefulness of mean platelet volume for predicting stroke risk in atrial fibrillation patients.

A 28-year-old right-handed male presented in December 2012 with complaints of numbness in the right arm and leg. Neurological examination revealed right hemiparesis and hemihypoesthesia. He had a history of epilepsy, and his mother had Sjogren syndrome. He reported that the numbness in the right arm and leg had started 2 years ago and he was then diagnosed with vasculitis, and thus, was administered 300 mg/day acetylsalicylic acid. Complete blood count, serum biochemistry, and sedimentation rate were normal. Immunological tests, including antinuclear, antiDNA, and antiphospholipids antibodies; laboratory tests for Lyme disease; ENA screening for Sjogren syndrome, syphilis, toxoplasmosis, hepatitis, HIV, CMV, tuberculosis, and sarcoidosis; and Schirmer’s and pathergy tests were negative. Magnetic resonance imaging of the brain revealed periventricular and pericallosal hyperintense lesions that were typical of MS (Figure 1, 2). Cerebrospinal fluid analysis revealed a cellular count of <3 cells/mm3 and protein level at 0.5 g/L with oligoclonal bands. His visual evoked potential revealed a delayed left P100 latency at 139.5 ms. He did not have any ocular symptoms. On ophthalmological evaluation, no ocular abnormalities were found. His ipsilateral delayed P100 latency was considered to be secondary to optic neuropathy. Immunomodulatory therapy (interferon beta 1-a) was initiated following the diagnosis of MS. He was admitted to our department in June 2013 with a complaint of decreased vision in the right and left eyes since the previous 2 days. Ophthalmoscopic examination of both the eyes revealed bilateral panuveitis. The patient was diagnosed with panuveitis associated with MS, and combination therapy with oral prednisolone at a dose of 64 mg/day and azathiopurine at a dose of 100 mg/day were initiated. The patient is still being followed up at our MS polyclinic without any new attack since 2013.

/pdf/multiple-sclerosis-and-panuveitis-a-rare-association-4lsjoasr85.pdf

Multiple Sclerosis and Panuveitis: A Rare Association

Ozet: Fahr hastaligi; bazal ganglionlar, serebellar dentat nukleus ve sentrum semiovalede kalsifikasyon gorulmesi ile karakterizedir. Bazal ganglionlar en sik tutulan bolgedir. Fahr sendromunun anoksi, radyasyon, sistemik hastaliklar, toksinler, kalsiyum metabolizma bozukluklari ve ensefalitler ile baglantili oldugu tanimlanmistir. Ayrica sendromun ailesel formu bildirilmistir. Sendromun klinik ozellikleri degisik olmasina ragmen; ilerleyici mental hasar, dizartri, konvulsiyon, parkinson benzeri klinik tablo, noro-psikiyatrik davranis ve zihinsel islev bozukluklari Fahr sendromunda siklikla gorulen klinik bulgulardir. Bu yazida gerilim tipi basagrisi bulunan Fahr sendromlu bir kadin olguyu sunmayi amacladik.

/pdf/gerilim-tipi-basagrisi-ve-fahr-hastaligi-birlikteligi-2qxr8k5p2j.pdf

Gerilim Tipi Başağrısı ve Fahr Hastalığı Birlikteliği

Aim: Myasthenia gravis (MG) is an autoimmune disease often caused by autoantibodies against postsynaptic acetylcholine receptors (AChR). It is known that vitamin D (VD), vitamin B12 and folic acid have some effects on the immune system. The aim of this study is to evaluate whether there is a difference in serum VD, vitamin B12 and folic acid levels in MG patients during the myasthenic crisis period compared to the non-crisis period.&#x0D; Material and Method: 32 patients followed up with the diagnosis of MG in Atatürk University Faculty of Medicine, Department of Neurology were included in the study. Serum 25(OH)D, vitamin B12 and folic acid levels were measured by taking blood from the antecubital vein in two different time periods, during the myasthenic crisis and during the non-crisis period, and periods were compared among themselves.&#x0D; Results: During the myasthenic crisis period, 25(OH)D level was 11.54 (1.08-50.33) ng/mL, vitamin B12 level was 299.5 (104-964) pg/mL, and folic acid level was 9.54±5.08 ng/mL. In the non-crisis period, 25(OH)D level was 18.74 (6.63-30.19) ng/mL, vitamin B12 level was 266 (119-678) pg/mL and folic acid level is 10.26±3.5 ng/mL. During the myasthenic crisis period, 25(OH)D vitamin levels of the patients were statistically significantly lower than the non-crisis period (p0.05).&#x0D; Conclusion: Low VD levels can be a facilitating factor in worsening myasthenic symptoms and entering myasthenic crisis. The use of VD supplements in MG patients with low VD levels may be beneficial in terms of protection from myasthenic crisis. Despite the limitations of our study, such as the small number of patients and the fact that 25(OH)D levels were not adjusted for seasonal effects, this study is the first study showing that VD levels are lower in the myasthenic crisis period than in the non-crisis period. 

/pdf/serum-25-hydroxy-vitamin-d-vitamin-b12-and-folic-acid-levels-1osq4d08.pdf

Serum 25-hydroxy vitamin D, vitamin B12 and folic acid levels in myasthenic crisis

Thrombotic Thrombocytopenic Purpura (TTP) characterized by thrombocytopenia, microangiopathic hemolytic anemia, neurological changes, renal failure, and fever is a life threatening, multisystem disease. The first was defined by Moskowitz in 1924. Thrombosis of small arterioles, venules and capillaries lead to cerebral micro-infarct. There are many neurological symptoms such as headache, seizures, changes in consciousness and mental, focal neurological changes. A case which was observed that neurological complications while the patient was monitoring with diagnose of TTP is presented.

/pdf/thrombotic-thrombocytopenic-purpura-and-ischemic-stroke-a-4nvl68jicw.pdf

Thrombotic thrombocytopenic purpura and ischemic stroke: A case report

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