Platelet Profile Distribution in Critically Ill Children

Gema Nazri Yanni

, Rina Amalia C. Saragih

Department of Child Health, Faculty of Medicine, Universitas Sumatera Utara, Haji Adam Malik General Hospital,

Medan, Indonesia

Keywords: Platelet, Critically Ill.

Abstract: Thrombocytopenia occurring in a critically ill patient is the result of hemodilution, increased platelet

consumption, an immune mechanism (increased platelet destruction), and increased platelet sequestration.

Previous studies showed that platelet indices might be a more useful prognostic indicator, but a study on

critically ill children is still limited. We report the platelet profile of critically ill children admitted in the

pediatric intensive care unit. This report is part of an ongoing study of the prognostic marker in critically ill

children that consist of septic and non-septic patients. All patients admitted to the pediatric intensive care

unit Haji Adam Malik Hospital and Universitas Sumatera Utara Hospital were recruited. We examined the

platelet profile (platelet count, Plateletcrit/PCT, Mean Platelet Volume /MPV and Platelet Distribution

Width/PDW) on the first day of admission. Of 53 samples, 29 were boys with an average age of 7.62

(+6.43) years old. Severe malnutrition was found in 12 cases (22.6%). We found platelet count median

value was 316000 (23000-828000). Median value of PCT, MPV, and PDW were 0.32 (0.08-1.40), 9.4 (7.9-

13.5), 9.7 (7.0-17.5), respectively. As the conclusion of this ongoing study, it is shown that there were

changes of platelet profile in critically ill children. Further studies studying its usefulness as a prognostic

indicator are still needed.

1 INTRODUCTION

Inflammation, regardless of its causes, is very

common during critical illness (Kellum et al, 1996).

One of the inflammation’s hallmarks is endothelial

dysfunction, which has an important role in the

pathogenesis of organ dysfunction and may be

associated with platelet activation and consumption

(Aird et al, 2003; Warkentin et al, 2003).

Studies had indicated that inflammation

associated endothelial dysfunction is one of the

causes of organ failure which is related to platelet

activation and consumption. According to these

findings, changes in platelet count are closely

associated with the prognosis of critically ill patients

(Aird et al, 2003; Vanderschueren et al, 2000;

Moreau et al, 2007).

Mean platelet volume (MPV) is defined as a ratio

of plateletcrit to platelet count and measured in

femtolitres. Larger platelets have more rapid respond

than smaller platelets, they can release chemical

mediators more readily in response either to

endogenous or exogenous stimuli (Becchi et al,

2006; Oncel et al, 2012; Gasparyan et al, 2011). The

association between changes of MPV level and

patient’s morbidity and mortality in various diseases

have been reported in several studies (Chu et al,

2010; Cho et al, 2013; Altintoprak et al, 2013;

Kandis et al, 2011; Aydemir et al, 2015; Vizioli et

al, 2009). However, studies in child population are

still limited. Only a few studies that had revealed the

association between MPV and early diagnosis

(O’Connor et al, 1993; Guida et al, 2003; Akarsu et

al, 2005; Oncel et al, 2012; Aksoy et al, 2012; Aydin

et al, 2014; Yao et al, 2015; Kim et al, 2015) or

mortality (Ahmad et al, 2014; Catal et al, 2014;

Zhao et al, 2015) of sepsis. , all of these studies were

performed in the neonatal period.

2 METHODS

This report is part of an ongoing study of a

prognostic marker in critically ill children. In this

paper, we describe the platelet profile specifically

platelet count, Plateletcrit /PCT, Mean Platelet

Volume /MPV and Platelet Distribution

Yanni, G. and Saragih, R.

Platelet Proﬁle Distribution in Critically Ill Children.

DOI: 10.5220/0010098808870890

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

887-890

ISBN: 978-989-758-449-7

887

Width/PDW) in critically ill children between Mei –

July 2018.

Inclusion criteria were all patients admitted to the

pediatric intensive care unit Haji Adam Malik

Hospital and Universitas Sumatera Utara Hospital

from one month until 18 years old. Patients with

malignancy, idiopathic thrombocytopenic purpura,

immunodeficiency, history of using chemotherapy

agent and refused for laboratory test were excluded.

Subjects were taken consecutively. The blood

sample was taken on the first day of admission .

Data were analyzed using SPSS version 20.

3 RESULT

The characteristics of all patients are presented in

Table

Table 1: Subjects Characteristics

Characteristic n = 53

Age (months), mean ± SD 7,6 (± 6,43)

Gender (n, %)

Boy

Girl

29 (54,7)

24 (45,3)

Nutritional Status (n, %)

Severe

Moderate

Normal

Overweight

12 (22,6)

7 (13,21)

33 (62,26)

1 (1,89)

n = total number of subject

Table 2 shows the platelet profile’s values. We

found that platelet count have a wide range. The

minimum level was 23000/ µL

(thrombocytopenia), and the maximum level was

828000/ µL (thrombocytosis). We also found the

minimum and maximum level of PCT were out of

normal range. The maximum level of MPV was

higher than the average value. The minimum level of

PDW was lower than average value.

Table 2: Platelet Profile

Platelet profile n = 53 Normal value

(population

mean)

Platelet count

(/µL), median

(min-max)

316000

(23000–828000)

150000-

450000

PCT (%),

median

(min-max)

0,3

(0,08–1,4)

(0,1-0,5)

MPV (fl),

median

(min-max)

9,4

(7,9–13,5)

(6,5-9,5)

PDW (%),

median

(min-max)

9,7

(7,0–17,5)

(10-18)

4 DISCUSSION

Our study found that platelet profile in critically ill

children on day one of admission had abnormal

value. In this study, we found subjects with

thrombocytopenia (<15000/ µL) and also

thrombocytosis (>450000/µL). Thrombocytopenia

was found on day one of admission , and it might be

because of varies underlying disease in critically ill

children.

Thrombocytopenia is one of the most frequent

laboratory abnormalities encountered in ICU, and

the reported incidence varies from 13 to 58% in

various studies (Strauss et al, 2002; Crowther et al,

2005; Aissaoui et al, 2007; Guida et al, 2003).

Various conditions have been identified as

underlying cause of thrombocytopenia, such as

disseminated intravascular coagulation, immune

mechanisms, reduced production, increased

consumption or irregular sequestration of platelets o

r a combination of these (Bogdonof et al, 1990;

Housinger et al, 1993). PCT reflects not only the

platelet count but also platelet size. In this study, we

found that minimum and maximum level of PCT

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

888

were out of laboratory normal range that reflect the

platelet count level.

MPV level was increased in this study. Mean

platelet volume (MPV) is one of the platelet indices

which is frequently used and routinely measured in

the complete blood count test with automatic

analyzer. MPV is defined as a ratio of plateletcrit to

platelet count and is measured in femtoliters (Zhang

et al, 2014). Van Der Leile et al have shown an

increase in MPV in septicemic patients (Van der

lelie et al, 1983), he postulated that with sepsis there

is increased thrombocytosis and this result in

increased megakaryocyte ploidy and an increase in

MPV.

PDW level in this study decreased. This result

was contradict with Patrick et al who studied PDW

level in neonates with late onset sepsis. He found

that PDW increased in sepsis (Patrick et al, 1990).

Based on this result, our ongoing study will

investigate the role of the platelet profile as

prognosic factors in critically ill children.

5 CONCLUSIONS

There were changes in platelet profile distribution in

critically ill children. Further studies studying its

usefulness as a prognostic indicator are still needed.

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