Brief Communication
Platelet size and volume distribution measured by automated platelet analyzer
A Pradalier1, N Abuaf2, JM Launay3, D Vincent1
Service de Médecine interne1 et Service d'Hematologie2, Hôpital Rothschild, Paris, France; Service de Biochimie3, Hôpital St Louis, Paris, France
Cephalalgia
Pradalier A, Abuaf N, Launay JM, Vincent D. Platelet size and volume distribution measured by automated platelet analyzer. Cephalalgia 1992;12:321-2. Oslo. ISSN 0333-1024 Thirty migraine without aura patients between attacks, 10 other during a migraine without aura attack and 30 normal subjects without headache were studied for platelet size and volume distribution using a new quantitative automated hematology analyzer (Coulter STKS). Platelet histograms, platelet counts and mean platelet volume were not significantly different in the three populations. • Headache, migraine, platelets A Pradalier, Service de Médecine Interne, Hôpitat Rothschild, Paris, France. Received 17 June 1992, accepted 2 July 1992
There has been extensive investigation of platelet function in the physiopathology of migraine (1-3). Indeed, it has been suggested that migraine is a primary disorder of platelets (4). Accordingly, change in platelet number, size, behavior and function might be expected in migraine. Damasio and Beck (5), in patients with thrombocytopenic purpura, and Bousser and Conrad (6), in patients with essential thrombocythemia, however, reported the development of headache attacks which could not be clinically distinguished from migraine but usually no changes in platelet size or number were demonstrated in migraine patients, using direct micro-scopical counting. Currently, more advanced platelet analyzers are available to measure platelet size and volume distribution in an improvement over direct microscopy. We have, therefore, reinvestigated platelets of migraine patients with this new approach. Materials and methods
Thirty migraine without aura patients (21F, 9M mean age 29 years, range 21 to 48) were diagnosed according to IHS criteria (7). They suffered 2-5 attacks a month. Prophylactic medication was withdrawn at least four days before study. Patients were studied during headache-free periods and compared to 30 normal subjects without headache (sex and age matched). Ten different migraine without aura patients (SF, 2M, mean age 33 years) were studied during an attack before treatment. Blood samples were drawn into a vacutainer containing EDTA. The blood was processed 30 min after sampling in a COULTER STKS, a quantitative automated analyzer which detects erythrocytes, leukocytes and platelets. In the platelet processor card, pulses representing cells from 2 to 20 fentoliters of volume were classified as platelets. To ensure that the platelet count and the size distribution curve accurately reflected the cell population, platelet sensing was extended for not more than four additional 4 sec periods whenever the platelet data accumulation was below a predetermined value. The analyzer computer recorded platelet size and volume. Statistical analysis was performed with the non-parametric two-tailed Komogorov-Smirnov test. A p-value < 0.05 was considered significant. Results and discussion
Platelet size and volume distribution histograms, platelet counts and mean platelet volume (MPV) did not significantly differ in migraine patients during or Table 1. Platelet volumes. Normal subjects
Migraine patients between attacks n = 30 n = 30 MPV 7.78 ± 1.12 fL 8.25 ± 0.69 fL PT 265,000 ± 68,000 290,000 ± 68,000 MPV= mean platelet volume; PT = platelet count; fL = fentoliter.
during attacks n = 10 7.91 ± 0.61 fL 283,700 ± 73,000
between attacks compared to normal subjects without headache (Table 1, Fig. 1). The STKS platelet counter is a method with high specificity and reproducibility (8) and provides accurate platelet counts in hematological disorders. Our study using the automated platelet analyzer failed to demonstrate change in platelet volume or size during or between attacks in migraine without aura patients. Platelet aggregation was not detected during migraine attacks either. The analyser is able to detect platelet aggregation because this alters volume distribution as well as platelet count. Platelet aggregates are detected as cells with a volume above 20 fentoliter (as leukocytes) in the presence of pseudo-thrombocytopenia. Our results do not eliminate the possibility that abnormal platelet behavior in migraine could be detected by other technology or that such abnormality might be found only in migraine with aura. References
1.
Anthony M, Hinterberger H, Lance J. The possible relationship of serotonin to the migraine syndrome. Res Clin Stud Headache 1969;2:29-59
2.
Launay JM, Pradalier A, Dreux C, Dry J. Platelet serotonin uptake and migraine. Cephalalgia 1962;2:57-9
3.
Malmgren R, Hasselmark L. The platelet and the neuron: two cells in focus in migraine. Cephalalgia 1988;8:7-24
4.
Hanington E, Jones RJ, Amess JAL, Wachowicz B. Migraine-a platelet disorder. Lancet 1981;ii:721-4
5.
Damasio H, Beck D. Migraine, thrombocytopenia and serotonin metabolism. Lancet 1978;i:240-1
6.
Bousser MG, Conrad J. TIAs, migraine and platelets. Headache 1987;27:552
7.
Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8( suppl 7)
8.
Jones AR, Hellman R, Twedt D. The Coulter counter leukocyte differential. Blood Cells 1985;11:203-40
Platelet size and volume distribution measured by automated platelet analyzer
A Pradalier1, N Abuaf2, JM Launay3, D Vincent1
Service de Médecine interne1 et Service d'Hematologie2, Hôpital Rothschild, Paris, France; Service de Biochimie3, Hôpital St Louis, Paris, France
Cephalalgia
Pradalier A, Abuaf N, Launay JM, Vincent D. Platelet size and volume distribution measured by automated platelet analyzer. Cephalalgia 1992;12:321-2. Oslo. ISSN 0333-1024 Thirty migraine without aura patients between attacks, 10 other during a migraine without aura attack and 30 normal subjects without headache were studied for platelet size and volume distribution using a new quantitative automated hematology analyzer (Coulter STKS). Platelet histograms, platelet counts and mean platelet volume were not significantly different in the three populations. • Headache, migraine, platelets A Pradalier, Service de Médecine Interne, Hôpitat Rothschild, Paris, France. Received 17 June 1992, accepted 2 July 1992
There has been extensive investigation of platelet function in the physiopathology of migraine (1-3). Indeed, it has been suggested that migraine is a primary disorder of platelets (4). Accordingly, change in platelet number, size, behavior and function might be expected in migraine. Damasio and Beck (5), in patients with thrombocytopenic purpura, and Bousser and Conrad (6), in patients with essential thrombocythemia, however, reported the development of headache attacks which could not be clinically distinguished from migraine but usually no changes in platelet size or number were demonstrated in migraine patients, using direct micro-scopical counting. Currently, more advanced platelet analyzers are available to measure platelet size and volume distribution in an improvement over direct microscopy. We have, therefore, reinvestigated platelets of migraine patients with this new approach. Materials and methods
Thirty migraine without aura patients (21F, 9M mean age 29 years, range 21 to 48) were diagnosed according to IHS criteria (7). They suffered 2-5 attacks a month. Prophylactic medication was withdrawn at least four days before study. Patients were studied during headache-free periods and compared to 30 normal subjects without headache (sex and age matched). Ten different migraine without aura patients (SF, 2M, mean age 33 years) were studied during an attack before treatment. Blood samples were drawn into a vacutainer containing EDTA. The blood was processed 30 min after sampling in a COULTER STKS, a quantitative automated analyzer which detects erythrocytes, leukocytes and platelets. In the platelet processor card, pulses representing cells from 2 to 20 fentoliters of volume were classified as platelets. To ensure that the platelet count and the size distribution curve accurately reflected the cell population, platelet sensing was extended for not more than four additional 4 sec periods whenever the platelet data accumulation was below a predetermined value. The analyzer computer recorded platelet size and volume. Statistical analysis was performed with the non-parametric two-tailed Komogorov-Smirnov test. A p-value < 0.05 was considered significant. Results and discussion
Platelet size and volume distribution histograms, platelet counts and mean platelet volume (MPV) did not significantly differ in migraine patients during or Table 1. Platelet volumes. Normal subjects
Migraine patients between attacks n = 30 n = 30 MPV 7.78 ± 1.12 fL 8.25 ± 0.69 fL PT 265,000 ± 68,000 290,000 ± 68,000 MPV= mean platelet volume; PT = platelet count; fL = fentoliter.
during attacks n = 10 7.91 ± 0.61 fL 283,700 ± 73,000
between attacks compared to normal subjects without headache (Table 1, Fig. 1). The STKS platelet counter is a method with high specificity and reproducibility (8) and provides accurate platelet counts in hematological disorders. Our study using the automated platelet analyzer failed to demonstrate change in platelet volume or size during or between attacks in migraine without aura patients. Platelet aggregation was not detected during migraine attacks either. The analyser is able to detect platelet aggregation because this alters volume distribution as well as platelet count. Platelet aggregates are detected as cells with a volume above 20 fentoliter (as leukocytes) in the presence of pseudo-thrombocytopenia. Our results do not eliminate the possibility that abnormal platelet behavior in migraine could be detected by other technology or that such abnormality might be found only in migraine with aura. References
1.
Anthony M, Hinterberger H, Lance J. The possible relationship of serotonin to the migraine syndrome. Res Clin Stud Headache 1969;2:29-59
2.
Launay JM, Pradalier A, Dreux C, Dry J. Platelet serotonin uptake and migraine. Cephalalgia 1962;2:57-9
3.
Malmgren R, Hasselmark L. The platelet and the neuron: two cells in focus in migraine. Cephalalgia 1988;8:7-24
4.
Hanington E, Jones RJ, Amess JAL, Wachowicz B. Migraine-a platelet disorder. Lancet 1981;ii:721-4
5.
Damasio H, Beck D. Migraine, thrombocytopenia and serotonin metabolism. Lancet 1978;i:240-1
6.
Bousser MG, Conrad J. TIAs, migraine and platelets. Headache 1987;27:552
7.
Headache Classification Committee of the International Headache Society: Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 1988;8( suppl 7)
8.
Jones AR, Hellman R, Twedt D. The Coulter counter leukocyte differential. Blood Cells 1985;11:203-40
