Abstract
Dear Editor,
We read with great interest the retrospective study by Demir and Abuzaid 1 evaluating the relationship of platelet parameters to prognosis in patients with oral cancer. Researchers found that the mean platelet volume (MPV) value is associated with the prognosis of oral cancer. We would like to emphasize the existence of some factors that may adversely affect the MPV data in this study.
Although the association with important diseases such as infections and malignancies has been reported, MPV measurement has not been standardized to date and therefore it is definitely not recommended for use for purposes such as diagnosis and prognosis, especially in acquired diseases. 2 The main variables that directly affect MPV measurement are the anticoagulant used in blood tubes, the time from blood collection to measurement, and the blood analyzers used in the measurement.3,4 In blood tubes containing ethylenediaminetetraacetic acid (EDTA), the most commonly used anticoagulant, contact of platelets with EDTA causes rapid swelling, undergoing a change in shape, and the formation of pseudopods. In platelets in contact with EDTA, the MPV value can increase up to 30% in the first five minutes and up to 40–45% in the first two hours. 3 MPV variability due to the use of EDTA as an anticoagulant has been reported between 2 and 50% in different studies.3,4 There are deviations in MPV values with other anticoagulants, too. Lance et al. showed that timing is important in MPV measurements and defined the optimal measurement time depending on whether the anticoagulant used was sodium citrate or EDTA as 60 minutes after and 120 minutes after blood collection, respectively. 5 Differences in the blood analyzers used in the measurement can also lead to a deviation of up to 40% in MPV values.4,6 The fact that the anticoagulant used in the blood tubes and the time from blood collection to measurement were not defined in the study by Demir and Abuzaid are the main factors that negatively affect the reliability of MPV data. Also, the study was carried out retrospectively in a situation that prevents the exclusion of preanalytical and analytical errors, and it is unacceptable that analytical errors could not be excluded, especially in the acquisition of MPV data. 7 Since there is no healthy control group in this study, it cannot be understood whether the platelet parameters obtained are also truly abnormal. In addition, the fact that research is carried out using only one type of blood analyzer and there is a significant deviation in MPV values between different blood analyzers prevents the universal use of the defined MPV cutoff value. Moreover, it is known that there is an inverse relationship between platelet size and number, and the detection of both high platelet count and high MPV in patients with poor prognosis in this study contradicts this known phylogenetic relationship. 8
In conclusion, MPV value may not be associated with the prognosis of oral cancer.
Footnotes
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Authorship statement
All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Cengiz Beyan and Esin Beyan. The first draft of the manuscript was written by Cengiz Beyan, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
