Correlating Bone Marrow Megakaryocytes and Platelet Parameters in ITP

Investigators, led by Weiwei Wang, MS, reported that a combined analysis of bone marrow megakaryocyte count, proportion of megakaryocytes at each stage, and platelet parameters returned a relevant reference value for the diagnosis of primary immune thrombocytopenia (ITP). Their experience was published in Clinical and Applied Thrombosis/Hemostasis.

The study enrolled 62 patients with newly diagnosed ITP and 40 healthy controls at the Fuyang People’s Hospital between January 2019 and October 2021. The diagnostic threshold for ITP was defined as a platelet count ≤100 × 10⁹/L, normal blood cell morphology, and non-enlarged spleen, as well as a bone marrow examination to rule out other secondary thrombocytopenia.

Immune Thrombocytopenia Diagnosis Strategy Results

The study used linear correlation, Pearson correlation, and receiver operating characteristic (ROC) curve analyses to assess relationships between megakaryocyte and platelet parameters. The authors observed that patients with ITP had significantly increased total number of megakaryocytes, promegakaryocytes, granular megakaryocytes, naked megakaryocytes, mean platelet volume (MPV), and platelet large cell ratio (P-LCR%) when compared to the controls (P<.05). Conversely, platelet-producing megakaryocytes, platelet count, and platelet pressure product were decreased in patients with ITP (P<.05).

Additionally, the researchers found that platelet count had a strong positive correlation with platelet pressure product (r = 0.921, P<.01), which itself was weakly positively correlated with MPV (r = 0.309; P<.05). Further, MPV was correlated with P-LCR (r = 0.856; P<.01). Platelet distribution width was weakly positively correlated with P-LCR (r = 0.296; P<.05) and megakaryocytes (r = 0.301; P<.05), but negatively correlated with promegakaryocytes (r = -0.336; P<.05).

After ROC curve analysis, the authors reported that platelet count, platelet pressure product, MPV, and P-LCR had diagnostic sensitivity of 100.0%, 81.0%, 74.6%, and 90.5%, respectively, and specificity of 100.0%, 92.5%, 80.0%, and 77.5%, respectively, for ITP.

Overall, the authors felt that the combined analysis of bone marrow megakaryocyte and platelet parameters had notable value for the diagnosis or exclusion of ITP, and they emphasized the low cost and ease of the examination.

Related: Outcomes of Kidney Transplants from Vaccine-Induced ITP Donors