The Laryngoscope C 2014 The American Laryngological, V
Rhinological and Otological Society, Inc.
Letter to the Editor
In Reference to Relation of Mean Platelet Volume and Red Blood Cell Distribution Width With Epistaxis
Dear Editor, We applaud the work by Kemal et al.,1 in their well-presented article. The authors found lower mean platelet volume (MPV) and red blood cell distribution (RDW) levels in epistaxis. It is worth noting that any process resulting in the release of immature erythrocyte/platelet or increased destruction of red blood cell/platelet will change the levels of RDW/MPV.2 Moreover, it has been reported that RDW is an index affected by many factors such as anemia, renal or hepatic dysfunction, thyroid disease, transfusion, acute or chronic inflammation, neurohumoral activation, malnutrition (i.e., iron, vitamin B12, and folic acid), ethnicity, bone marrow depression, and use of some medications (i.e., erythropoietin and antibiotics).2 Meanwhile, MPV may act through thrombosis, which is also affected by many factors such as diabetes mellitus, prediabetes, obesity, coronary heart disease, hypercholesterolemia, smoking, metabolic syndrome, hypertension, statins, antihypertensive drug use, and atrial fibrillation.3 In addition, a decreased MPV has been reported in patients with ulcerative colitis, rheumatoid arthritis, and ankylosing spondylitis,4–6 and it has also been reported that hypothyroidism increases MPV values.7 Thus, it would have been better if the authors had listed these RDW/MPV-affecting factors in greater detail. In addition, several issues should be noted. First, the time elapsed between blood sampling and RDW/ MPV measuring was not clearly defined; the length of this interval may significantly alter their levels.2 Second, from Table II we found that the average age of subjects in the control group was significantly higher than that of subjects in the epistaxis group. Levels of RDW have been shown to be associated with age.8 Finally, from Table I, we saw that whether the level of MPV or RDW, the differences between the two groups were small.
The difference between the two groups was statistically significant, and considering the above-mentioned limitations of this study and the relatively small sample size, this small difference may not be clinically significant. XIA FENG, BM JIAN–YONG ZHANG, MD Second Department of Respiration Affiliated Hospital of Zunyi Medical College Zunyi, Guizhou, China
LIBING JIANG, BM YUE–FENG MA, MD, PHD Department of Emergency Medicine Second Affiliated Hospital School of Medicine & Institute of Emergency Medicine Zhejiang University Hangzhou, China
BIBLIOGRAPHY 1. Kemal O, Muderris T, Sevil E, Kutlar G. Relation of Mean platelet volume and red blood cell distribution width with epistaxis [published online ahead of print October 24, 2014]. Laryngoscope. doi: 10.1002/lary.24990. 2. Karagoz E, Tanoglu A. Red Blood cell distribution width: an emerging diagnostic factor of acute appendicitis? World J Emerg Surg 2013;8:54. 3. Varol E. Mean platelet volume in supraventricular tachyarrhythmia can be affected by many cardiovascular risk factors. Afr Health Sci 2013;13: 1176–1177. 4. Yuksel O, Helvaci K, Basar O, et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets 2009;20: 277–281. 5. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75:291–294. 6. Danese S, Motte Cd Cde L, Fiocchi C. Platelets in inflammatory bowel disease: clinical, pathogenic, and therapeutic implications. Am J Gastroenterol 2004;99:938–945. 7. Erikci AA, Karagoz B, Ozturk A, et al. The effect of subclinical hypothyroidism on platelet parameters. Hematology 2009;14:115–117. 8. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J 2009;50:301–312.
DOI: 10.1002/lary.25099
Laryngoscope 125: June 2015
Feng et al.: Letter to the Editor
E223
Rhinological and Otological Society, Inc.
Letter to the Editor
In Reference to Relation of Mean Platelet Volume and Red Blood Cell Distribution Width With Epistaxis
Dear Editor, We applaud the work by Kemal et al.,1 in their well-presented article. The authors found lower mean platelet volume (MPV) and red blood cell distribution (RDW) levels in epistaxis. It is worth noting that any process resulting in the release of immature erythrocyte/platelet or increased destruction of red blood cell/platelet will change the levels of RDW/MPV.2 Moreover, it has been reported that RDW is an index affected by many factors such as anemia, renal or hepatic dysfunction, thyroid disease, transfusion, acute or chronic inflammation, neurohumoral activation, malnutrition (i.e., iron, vitamin B12, and folic acid), ethnicity, bone marrow depression, and use of some medications (i.e., erythropoietin and antibiotics).2 Meanwhile, MPV may act through thrombosis, which is also affected by many factors such as diabetes mellitus, prediabetes, obesity, coronary heart disease, hypercholesterolemia, smoking, metabolic syndrome, hypertension, statins, antihypertensive drug use, and atrial fibrillation.3 In addition, a decreased MPV has been reported in patients with ulcerative colitis, rheumatoid arthritis, and ankylosing spondylitis,4–6 and it has also been reported that hypothyroidism increases MPV values.7 Thus, it would have been better if the authors had listed these RDW/MPV-affecting factors in greater detail. In addition, several issues should be noted. First, the time elapsed between blood sampling and RDW/ MPV measuring was not clearly defined; the length of this interval may significantly alter their levels.2 Second, from Table II we found that the average age of subjects in the control group was significantly higher than that of subjects in the epistaxis group. Levels of RDW have been shown to be associated with age.8 Finally, from Table I, we saw that whether the level of MPV or RDW, the differences between the two groups were small.
The difference between the two groups was statistically significant, and considering the above-mentioned limitations of this study and the relatively small sample size, this small difference may not be clinically significant. XIA FENG, BM JIAN–YONG ZHANG, MD Second Department of Respiration Affiliated Hospital of Zunyi Medical College Zunyi, Guizhou, China
LIBING JIANG, BM YUE–FENG MA, MD, PHD Department of Emergency Medicine Second Affiliated Hospital School of Medicine & Institute of Emergency Medicine Zhejiang University Hangzhou, China
BIBLIOGRAPHY 1. Kemal O, Muderris T, Sevil E, Kutlar G. Relation of Mean platelet volume and red blood cell distribution width with epistaxis [published online ahead of print October 24, 2014]. Laryngoscope. doi: 10.1002/lary.24990. 2. Karagoz E, Tanoglu A. Red Blood cell distribution width: an emerging diagnostic factor of acute appendicitis? World J Emerg Surg 2013;8:54. 3. Varol E. Mean platelet volume in supraventricular tachyarrhythmia can be affected by many cardiovascular risk factors. Afr Health Sci 2013;13: 1176–1177. 4. Yuksel O, Helvaci K, Basar O, et al. An overlooked indicator of disease activity in ulcerative colitis: mean platelet volume. Platelets 2009;20: 277–281. 5. Kisacik B, Tufan A, Kalyoncu U, et al. Mean platelet volume (MPV) as an inflammatory marker in ankylosing spondylitis and rheumatoid arthritis. Joint Bone Spine 2008;75:291–294. 6. Danese S, Motte Cd Cde L, Fiocchi C. Platelets in inflammatory bowel disease: clinical, pathogenic, and therapeutic implications. Am J Gastroenterol 2004;99:938–945. 7. Erikci AA, Karagoz B, Ozturk A, et al. The effect of subclinical hypothyroidism on platelet parameters. Hematology 2009;14:115–117. 8. Fukuta H, Ohte N, Mukai S, et al. Elevated plasma levels of B-type natriuretic peptide but not C-reactive protein are associated with higher red cell distribution width in patients with coronary artery disease. Int Heart J 2009;50:301–312.
DOI: 10.1002/lary.25099
Laryngoscope 125: June 2015
Feng et al.: Letter to the Editor
E223
