http://informahealthcare.com/plt ISSN: 0953-7104 (print), 1369-1635 (electronic) Platelets, 2015; 26(3): 274 ! 2014 Informa UK Ltd. DOI: 10.3109/09537104.2013.867939

LETTER TO THE EDITOR

Mean platelet volume and red cell distribution width in autoimmune gastritis: Confounding factors should be considered Ercan Varol & Mehmet Ozaydin Department of Cardiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey

We read the article by Tuzun et al. with great interest [1]. They investigated whether mean platelet volume (MPV), plateletcrit and red cell distribution width (RDW) have any predictive role in the discrimination of autoimmune gastritis patients with and without gastric carcinoid tumors. Plateletcrit and RDW were significantly higher in autoimmune gastritis patients compared to the control group. There was no significant difference in MPV between two groups. There was also no significant difference in MPV, plateletcrit and RDW between autoimmune gastritis patients without carcinoid tumor and patients with carcinoid tumors. This is an interesting study and we congratulate the authors. However, we want to make minor criticism about this study from methodological aspect. Basically, the method used for MPV assessment is correct. However, it has to be kept in mind that there are significant associations of MPV with smoking, obesity, coronary artery disease, metabolic syndrome, nonalcoholic steatohepatitis, statin use and atrial fibrillation [2–4]. Although they pointed out that they excluded the hypertension, diabetes mellitus, hyperlipidemia, coronary artery disease and antiplatelet drug use, they did not mention about the body mass index, smoking status, presence and incidence of metabolic syndrome and non-alcoholic steatohepatitis. Previous studies showed that obesity, smoking, non-alcoholic steatohepatitis and metabolic syndrome increase MPV [2–4]. Moreover, they did not mention about the hemoglobin concentration. They found that Vit B12 and ferritin levels were significantly lower in autoimmune gastritis patients compared to the control group. There might be anemia in autoimmune gastritis patients. However, data of hemoglobin levels are lacking. Elevation of RDW in patients with autoimmune gastritis may result from iron deficiency or vitamin B12 deficiency anemia. As a result, these factors must have been taken into account. MPV is universally available with routine blood counts by automated hemograms and a simple and easy method of assessing platelet function. In comparison to smaller ones, larger platelets have more granules, aggregate more rapidly with collagen, have higher thromboxane A2 level and express more glycoprotein Ib and IIb/IIIa receptors [2, 5]. Platelet activation plays a major role in the pathophysiology of diseases prone to thrombosis and inflammation, and in line with this MPV might be a link between

Correspondence: Ercan Varol, Department of Cardiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey. Tel: +90 5323468258. Fax: +90 2462324510. E-mail: [email protected]

Keywords Autoimmune gastritis, mean platelet volume, red cell distribution width History Received 6 November 2013 Revised 17 November 2013 Accepted 18 November 2013 Published online 16 January 2014

thrombosis and inflammation [6]. We believe that MPV can be affected by many inflammatory and cardiovascular risk factors. If the authors had taken into account the above mentioned confounding factors, they might have found different results.

Declaration of interest The authors declare no conflicts of interests. The authors alone are responsible for the content and writing of this article.

References 1. Tuzun A, Keskin O, Yakut M, Kalkan C, Soykan I. The predictive value of mean platelet volume, plateletcrit and red cell distribution width in the differentiation of autoimmune gastritis patients with and without type I gastric carcinoid tumors. Platelets 2013 Oct 31. [Epub ahead of print]. 2. Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract 2009;63:1509–1515. [Review]. 3. Celikbilek M, Gursoy S, Deniz K, Karaman A, Zararsiz G, Yurci A. Mean platelet volume in biopsy-proven non-alcoholic fatty liver disease. Platelets 2013;24:194–199. 4. Varol E, Icli A, Kocyigit S, Erdogan D, Ozaydin M, Dogan A. Effect of smoking cessation on mean platelet volume. Clin Appl Thromb Hemost 2013;19:315–319. 5. Park Y, Schoene N, Harris W. Mean platelet volume as an indicator of platelet activation: Methodological issues. Platelets 2002;13: 301–306. 6. Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: A link between thrombosis and inflammation? Curr Pharm Des 2011;17:47–58.

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Mean platelet volume and red cell distribution width in autoimmune gastritis: confounding factors should be considered.

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