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 Table of Contents  
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 31-34

Recent advances in platelet distribution width

Department of Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, Tamil Nadu, India

Date of Submission28-Oct-2021
Date of Acceptance30-Oct-2021
Date of Web Publication22-Dec-2021

Correspondence Address:
R Priyadharshini
Department of Pathology, Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai - 600 007, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijcpc.ijcpc_12_21

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Platelet distribution width (PDW) is a regular parameter in blood routine examination which reflects the variation of platelet size distribution with a range from 8.3% to 56.6%. PDW is a measure of platelet anisocytosis dependent on individual platelet volume distribution. Thrombocrit (or plateletcrit) is the percentage of blood volume occupied by platelets and is an assessment of circulating platelet mass. Platelets in whole blood can be detected using the same electrical or electro-optical measurement methods that are being used to count red cells. Platelets must be separated from red cells using an upper threshold, whereas debris and electrical noise must be separated using a lower threshold. Many recent advancements in terms of PDW have been demonstrated in this research. First, it was tested whether the PDW was based on both mean platelet volume and Platelet (Thrombocyte) count Test (PLT) in a population of patients with high PLTs. In the second stage, we looked into whether combining these three parameters could help differentiate between patients with reactive and autonomous thrombocytosis. Other studies are needed to validate these preliminary findings, and they should be expanded to include PDW tested on other automated blood counters.

Keywords: Innovative technique, mean platelet volume, platelet count, platelet distribution width platelets, thrombocythemia

How to cite this article:
Kumari S, Priyadharshini R, Palati S. Recent advances in platelet distribution width. Int J Clinicopathol Correl 2021;5:31-4

How to cite this URL:
Kumari S, Priyadharshini R, Palati S. Recent advances in platelet distribution width. Int J Clinicopathol Correl [serial online] 2021 [cited 2022 Jan 19];5:31-4. Available from: https://www.ijcpc.org/text.asp?2021/5/2/31/333387

  Introduction Top

Platelets in whole blood can be counted using the same electrical or electro-optical measurement methods that are used to count red cells. Separating platelets from red cells necessitate an upper threshold, whereas separating platelets from debris and electrical noise necessitate a lower threshold. Red cell recirculation near the aperture should be avoided because the pulses emitted can be mistaken for platelet pulses.[1] Giant platelets being mistaken for red cells or ethylenediaminetetraacetic acid-induced platelet clumping or satellitism can cause falsely low impedance platelet counts. Fast platelet counts may be due to microcytic or broken red cells, white cell fragments in leukemia 84, or bacteria or fungi, which is misleading.[2] The present study is a review-based study.

Total number of articles collected was twenty. Qualitative analysis of these twenty articles was done, and the details were represented. Data were collected through sources such as ResearchGate, Google Scholar, and PubMed. The duration of the article's publication period was from January 2000 to March 2021. Number of articles selected was verified, filtered, and identified. Five steps in article selection include identification of relevant articles, selection, and data extraction and charting. Analysis was done, and a report was prepared. Only those articles were included which had specific alternatives and recent advancements in platelet distribution width (PDW). Articles that did not fit the selection criteria were excluded.

  Platelet Distribution Width Top

PDW is a regular parameter in blood routine examination which reflects the variation of platelet size distribution with a range from 8.3% to 56.6%. PDW can be also termed as a measurement of platelet anisocytosis calculated from the distribution of individual platelet volumes. Thrombocrit (or plateletcrit) is said to be the percentage of blood volume occupied by platelets which can be carried out for the circulation of platelet mass.[3] An optical fluorescence platelet count has been introduced on some Sysmex analyzers, in addition to the traditional impedance count.

The RNA of reticulocytes and platelet membranes and granules is stained with a dye. The fluorescent staining of the platelets allows the exclusion of nonplatelet particles from the count and also allows the inclusion of large or giant platelets. The impedance count is sometimes more precise for samples from patients receiving cytotoxic chemotherapy. This is probably due to the erroneous staining of white cell fragments following apoptosis.[4] In health, there are approximately 150–400 × 109 platelets per liter of blood. The counts are somewhat higher in women than in men, and there is cycling, with slightly lower counts at about the time of menstruation. In apparently healthy Afro-Caribbean and Africans, platelet counts are lower than in Caucasians. The PDW, which is a measure of platelet anisocytosis, and the “plateletcrit,” which is the product of the mean platelet volume (MPV) and platelet count and, like the hematocrit, can be used to estimate the amount of circulating platelets per unit volume of blood.[5]

  Clinical Correlation Of Platelet Distribution Width Top

The platelet-large cell ratio (P-LCR) was reported by some of the instruments, and the number of platelets falling above the 12 fl threshold on the platelet size histogram was divided by the total number of platelets. A high P-LCR or PDW indicates peripheral immune destruction of platelets. The PDW helps in distinguishing essential thrombocythemia (PDW increased) from reactive thrombocytosis (PDW normal). The plateletcrit does not provide any information of clinical value. All derived platelet parameters are highly specific to the individual technologies, with different analyzers having different normal ranges.[6] In terms of reticulated platelets and immature platelet fraction (IPF), once the labeling is done with specific immunological markers and a fluorescent dye that binds RNA, it is possible to identify young platelets with a higher RNA content by flow cytometry. By correlation with the reticulocyte count, these have been called “reticulated platelets,” and it has been suggested that an increased number in the circulation is a sensitive and early indication of recovery of thrombopoiesis in aplastic anemia. However, because there is a constant exchange of platelets between the circulation and the spleen, it is not clear whether their presence in the blood has the same significance as reticulocytes.

On some Sysmex instruments, a new automated method for quantifying reticulated platelets, known as the IPF, has been developed. A fluorescent dye-containing polymethine and oxazine are used to calculate the IPF. These two dyes penetrate the cell membrane, staining some RNA in red cells and platelets, before passing the stained cells through a semiconductor diode beam laser. Reticulocytes and reticulated platelets are characterized by measuring the forward light scatter (cell volume) and fluorescence intensity (RNA content). Patients with peripheral platelet consumption/destruction (autoimmune thrombocytopenic purpura and thrombotic thrombocytopenic purpura) have a higher IPF value, whereas patients with marrow failure have an average or low value. Larger platelets and increased MPV consistently are inversely correlated to platelet numbers, which thus may assure the clinician that a thrombocytopenia in the patient is real and not a laboratory error. Since large platelets are more mechanically involved, some dogs with platelet counts <10,000/l do not bleed excessively. Platelets on blood smears often have pseudopodia and an irregular shape, indicating platelet activation during blood collection and handling.[7]

  Inclusion of Platelet Distribution Width in 5 Part Automated Analyser Top

A fully automated full blood count, including a platelet count, first became available in the 1970s, and it rendered possible the ability to additionally measure other important parameters. The MPV, PDW, and platelet wide cell ratio are all dependent on platelet distribution (P-LCR). With the ultimate technological convergence of flow cytometric and aperture impedance principles, platelet counting can now also be performed by either optical (one-dimensional or two-dimensional scatter and fluorescence) or immunological methods (e.g.,-CD61 ImmunoPLATE), which may be more accurate in some samples, the latter providing the basis of a new, very precise flow cytometric reference method for platelet counting (i.e., the platelet/RBC ratio).[8]

MPV and PDW are termed as platelet indices, which increase during platelet activation. To obtain a larger surface platelet, a change in shape is observed during activation. Their shape changes from discoid to spherical. Pseudopodia are formed as well at the time of activation. PDW is a more specific indicator of platelet activation than MPV since it is not elevated during single platelet distension caused by platelet swelling. The combined use of MPV and PDW could predict the activation of coagulation more efficiently and effectively.[9]

  Mean Platelet Volume and Platelet Distribution Width Top

Platelets can be counted using the same techniques of electrical or electro-optical detection and are used for counting red cells. PDW can be termed as a measurement of platelet anisocytosis calculated from the distribution of individual platelet volumes. PDW is also said to be a regular parameter in blood routine examination which shows the variation of platelet size distribution with a range from 8.3% to 56.6%.

Despite the fact that platelet parameters such as the MPV and PDW have been available to clinicians for some time, their importance in patient diagnosis and management is still unknown.[10] Several studies tried to use MPV and (or) PDW to distinguish between RT and thrombocytosis associated with MPD. Although they constantly gave out significant differences between the two groups with respect to MPV and PDW, the sensitivity was not sufficient to allow differential diagnosis in an individual patient. All of these researches, on the other hand, interpreted PDW separately from MPV and PLT. Despite the fact that platelet parameters such as MPV and PDW have been available for some time, their clinical utility has been limited due to the likelihood that they are affected by the time between blood collection and examination. Furthermore, PDW was calculated differently on various instruments.[11] PDW expresses the distribution of the size of platelets produced by the megakaryocyte. In cases of autonomous platelet hyperproduction, the megakaryocyte's influence over platelet size is likely to be impaired, as demonstrated by an expanded dispersion. Intuitively, it seemed preferable in such cases to explain that, for a given PLT and MPV value, the PDW was high, and thereby for a given PDW, the MPV, or the PLT was too low.

The increased PDW residual probably reflects a dysregulation in thrombopoiesis, which is also translated by the multiple abnormalities of platelet reactivity and the change in platelet membrane and adenine nucleotide content that have been previously described. By using a parameter such as PDW, we were able to achieve a fairly interesting resolution between reactive and autonomous thrombocytosis.[12] This approach is costless and effortless and requires only the creation of a laboratory database and the use of a simple linear multiple regression model; the megakaryocyte's control over platelet size is likely to be compromised in cases of autonomous platelet hyperproduction, as evidenced by an increased dispersion. These preliminary data need to be confirmed by other studies for future purposes and should be extended to PDW measured on other automated blood counters.[13] Our team has extensive knowledge and research experience that has translated into high-quality publications[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33]

  Conclusion Top

This review overviewed the PDW in different aspects including its analysis and principle, clinical implications, and synergistic use of MPV. PDW is a regular parameter in blood routine examination which reflects variation of platelet size distribution with a range from 8.3% to 56.6%. It should be analyzed along with other hematological parameters as a theranostic and prognostic factor.


We would like to thank Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University for providing us support to conduct the study.

Financial support and sponsorship

The present project is supported by

• Jeevan clinic

• Saveetha Institute of Medical and Technical Sciences

• Saveetha Dental College and Hospitals,

• Saveetha University.

Conflicts of interest

There are no conflicts of interest.

  References Top

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Li H, Jiao J. Association of gender difference to Platelet Count (PC), Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) Levels in Non-alcoholic Fatty Liver Disease (NAFLD) patients. J Coll Physicians Surg Pak 2021;31:115-6.  Back to cited text no. 2
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