Predicting the Severity of Henoch–Schönlein Purpura: The Role of the Functional Platelet Indices

Abstract

Objecive: Our aim is to measure the discriminative competency of the qualitative platelet indices obtained at the time of diagnosis on the severity and outcome of Henoch-Schönlein purpura (HSP).

Materials and Methods: Electronic data of consecutive HSP children were extracted. The severity of the disease was estimated by an adopted clinical scoring system. Platelet count (PLT), mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) indices at the time of diagnosis were recorded.

Results: Overall, 76 HSP patients (mean age: 7.4±2.5 years, 56.5% male) were evaluated. HSP was classified as mild in 59 (77.6%) cases and severe in 17 (22.4%). MPV was significantly lower in severe HSP patients (7.6±1 vs. 8.44±1.1, p<0.01), however, there was no significant difference for PCT and PDW parameters. Relapse occurred in 14 patients (18.4%, 5 mild HSP and 9 severe HSP patients) during follow up. Severe HSP cases were more prone to relapse (p<0.01) and relapsing HSP patients had lower PDW (13.2±3.1 vs. 14.8±2.4 p<0.05).

Conclusions: MPV level obtained at the time of first presentation of the HSP disease has a discriminative value for mild and severe HSP. Also, lower PDW might be predictive to suspect the HSP patients susceptive to relapse.

Keywords

• Children,Henoch-Schönlein purpura,mean platelet volume,platelet distribution width,plateletcrit

Henoch-Schönlein Purpurasının Ciddiyetini Öngörmek: Fonksiyonel Trombosit Belirteçlerinin Rolü

Öz

Amaç: Amacımız tanı anında saptanan kalitatif trombosit belirteçlerinin Henoch-Schönlein purpurası’ndaki (HSP) hastalık şiddeti ve gidişatının belirlenmesindeki yeterliliğinin değerlendirilmesidir.

Materyal ve Metot: HSP hastası çocukların elektronik verileri tarandı. Hastalığın ciddiyeti adapte edilmiş bir klinik skorlama sistemi ile belirlendi. Tanı anındaki trombosit sayısı, ortalama trombosit hacmi (MPV), plateletkrit (PCT) ve trombosit dağılım genişliği (PDW) belirteçleri kaydedildi.

Bulgular: Toplam 76 HSP hastası (ortalama yaş: 7,4±2,5 yıl, %56,5 erkek) değerlendirildi, 59 (%77,6) olguda HSP hafif ve 17 (%22,4) olguda ciddiydi. Ciddi HSP olgularında MPV belirgin olarak düşüktü (7,6±1,0 vs. 8,44±1,1, p<0,01), ancak PCT ve PDW belirteçlerinde anlamlı bir fark yoktu. Hastaların 14’ünde relaps izlendi (%18,4, 5 hafif HSP ve 9 ciddi HSP olgusu). Ciddi HSP olgularında relapsa yatkınlık daha fazlaydı (p<0,01) ve relaps olan hastalarda PDW daha düşüktü (13,2±3,1 vs. 14,8±2,4 p<0,05).

Sonuç: HSP olgularında tanı anında saptanan MPV düzeyleri hafif ve ciddi hastalığın ayrımında faydalıdır. Ayrıca, düşük PDW düzeyleri relapse yatkınlığı olan HSP hastalarının ön görülmesinde yararlı olabilir.

Anahtar Kelimeler

• Çocuk,Henoch-Schönlein purpura,ortalama trombosit hacmi,plateletkrit,trombosit dağılım genişliği

Kaynakça

1. 1. Gardner-Medwin JM, Dolezalova P, Cummins C, Southwood TR. Incidence of Henoch–Schonlein purpura, Kawasaki disease, and rare vasculitides in children of different ethnic origins. Lancet. 2002;360:1197-1202.
2. 2. Çakıcı EK, Gür G, Yazılıtaş F, ve ark. A retrospective analysis of children with Henoch-Schonlein purpura and re-evaluation of renal pathologies using Oxford classification. Clin Exp Nephrol. 2019;23(7):939-947. doi: 10.1007/s10157-019-01726-5
3. 3. Elmas AT, Tabel Y. Platelet Counts in Children with Henoch-Schonlein Purpura Relationship to Renal Involvement. J Clin Lab Anal. 2016;30(1):71-74.
4. 4. Thompson CB, Eaton KA, Princiotta SM, Rushin CA, Valeri CR. Size dependent platelet subpopulations: relationship of platelet volume to ultrastructure, enzymatic activity, and function. Br J Haematol. 1982;50(3):509-519.
5. 5. Bowles KM, Cooke LJ, Richards EM, Baglin TP. Platelet size has diagnostic predictive value in patients with thrombocytopenia. Clin Lab Haematol. 2005;27(6):370-373.
6. 6. Makay B, Türkyilmaz Z, Duman M, Unsal E. Mean platelet volume in Henoch-Schönlein purpura: relationship to gastrointestinal bleeding. Clin Rheumatol. 2009;28(10):1225-1228.
7. 7. Ozen S, Ruperto N, Dillon MJ, ve ark. EULAR/PReS endorsed consensus criteria for the classification of childhood vasculitides. Ann Rheum Dis. 2006;65(7):936-941.
8. 8. De Mattia D, Penza R, Giordano P, ve ark. von Willebrand factor and factor XIII in children with Henoch-Schonlein purpura. Pediatr Nephrol. 1995;9(5):603-605.

9. 9. Muslu A, Islek I, Gok F, ve ark. Endothelin levels in Henoch-Schonlein purpura. Pediatr Nephrol. 2002;17(11):920-925.
10. 10. Fessatou S, Nicolaidou P, Gourgiotis D, ve ark. Endothelin 1 levels in relation to clinical presentation and outcome of Henoch Schonlein purpura. BMC Pediatr. 2008;8:33.
11. 11. Kisacik B, Tufan A, Kalyoncu U, ve ark. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine. 2008;75(3):291-294.
12. 12. Kapsoritakis AN, Koukourakis MI, Sfiridaki A, ve ark. Mean platelet volume: a useful marker of inflammatory bowel disease activity. Am J Gastroenterol. 2001;96(3):776-781.
13. 13. Yüksel O, Helvaci K, Başar O, ve ark. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets. 2009;20(4):277-281.
14. 14. Culic S, Jakl R, Metlicic V, ve ark. Platelet function analysis in children with Schönlein-Henoch syndrome. Arch Med Res. 2001;32(4):268-72.
15. 15. Collins CE, Rampton DS, Rogers J, Williams NS. Platelet aggregation and neutrophil sequestration in the mesenteric circulation in inflammatory bowel disease. Eur J Gastroenterol Hepatol. 1997;9:1213-1217.
16. 16. Rostoker G, Rymer JC, Bagnard G, Petit-Phar M, Griuncelli M, Pilatte Y. Imbalances in serum proinflammatory cytokines and their soluble receptors: a putative role in the progression of idiopathic IgA nephropathy (IgAN) and Henoch-Schonlein purpura nephritis, and a potential target of immunoglobulin therapy? Clin Exp Immunol. 1998;114(3):468-476.
17. 17. Wu TH, Wu SC, Huang TP, Yu CL, Tsai CY: Increased excretion of tumor necrosis factor alpha and interleukin 1 beta in urine from patients with IgA nephropathy and Henoch-Schonlein purpura. Nephron. 1996;74(1):79-88.
18. 18. Gasparyan AY, Sandoo A, Stavropoulos-Kalinoglou A, Kitas GD. Mean platelet volume in patients with rheumatoid arthritis: the effect of anti-TNF-α therapy. Rheumatol Int. 2010;30(8):1125-1129.
19. 19. van Gameren MM, Willemse PH, Mulder NH, ve ark. Effects of recombinant human interleukin-6 in cancer patients: a phase I-II study. Blood. 1994;84(5):1434-1441.
20. 20. Vagdatli E, Gounari E, Lazaridou E, Katsibourlia E, Tsikopoulou F, Labrianou I. Platelet distribution width: a simple, practical and specific marker of activation of coagulation. Hippokratia. 2010;14(1):28-32.