Question 1

What is an MPV blood test?

Accepted Answer

The mean platelet volume (MPV) test is a blood test conducted as part of a full blood count test that determines the average size of platelets.[1] Platelets, also known as thrombocytes, are very small cell fragments from a large bone marrow cell called megakaryocyte; for this reason, platelets do not have a nucleus.

Platelet formation is regulated by thrombopoietin, which is a hormone that promotes the growth and development of megakaryocytes. Some inflammatory molecules may also participate in the production of platelets.[2]

The main objective of platelets is the maintenance of haemostasis, which is the functional process that prevents and stops bleeding. If there is no injury, platelets remain inactive in the blood. However, whenever bleeding is detected, platelets become activated by signalling molecules from the coagulation cascade. Activated platelets gather together in the damaged site and promote clot formation.[2]

Platelets also participate in immune responses and may even have a critical role. Platelets can become activated by inflammatory signalling molecules, and they quickly gather at the sites of injury or infection, even without active bleeding. Research has shown that platelets participate in the activation of immune cells, reduce collateral damage, and even destroy infectious organisms.[3]

The normal life cycle of a platelet is 8 to 12 days in the blood,[2] and a portion of their total count is secluded in the spleen.[1][2]

Question 2

What is an MPV test used for?

Accepted Answer

The conventional use of an MPV test is during the assessment of thrombocytopenia (low platelet count). In this scenario, an MPV test is employed for differentiating between the multiple causes of thrombocytopenia.[4][5]

Its purpose during the diagnosis of thrombocytosis (high platelet count) is less clear and, therefore, not routinely utilised in clinical practice.[5]

A mean platelet volume test is not usually indicated as an independent exam; most of the time, it should be interpreted at least alongside a platelet count. This is included by default when you take a Vitall full blood count test, alongside other platelet tests.

In recent years, the MPV test has gained renowned interest from the medical and scientific community. Studies have reported that MPV may be a new marker for vascular disease;[6][7] as a result, it may be altered in conditions associated with increased clot formation. This includes heart attack, stroke, hypertension, diabetes, obesity, smoking, some types of cancer,[6] pulmonary embolism,[8] pre-eclampsia,[9] and other conditions.

Certain conditions unrelated to clot formation may also present an altered MPV; for example, pneumoconiosis, non-alcoholic fatty liver disease, psoriasis, and varicocele.[6]

However, it is important to remember that this is still under investigation, and there is no clear consensus for its application in clinical practice.[6][7]

Question 3

When should I take an MPV blood test?

Accepted Answer

You will usually have to take this test if you have had low platelet counts before and there is no evident cause for it. Some conditions frequently associated with low platelet counts and altered MPV include bleeding problems, bone marrow problems, autoimmunity, viral infections, certain types of cancer, and chemotherapy.

An MPV blood test is usually indicated when there is a problem with your platelets or when your GP is suspecting it. However, if your doctor requests a full blood count (which includes a mean platelet volume test), it does not necessarily mean that there is a platelet-related problem; if you feel unsure, you should discuss it with your GP.

If you already know that you have a condition that may alter your platelets, your GP may repeatedly indicate this test for prognostic purposes or checking if your MPV has changed after treatment.

Question 4

What is the process for an MPV blood test?

Accepted Answer

An MPV test requires a blood sample, which can be taken directly from a vein with a needle or by a finger-prick. It is frequently tested as part of a full blood count. The test does not usually need any special preparation. If there are special requirements (such as stopping a medication) before taking your sample, please check with your GP.

A finger-prick test from Vitall is a very simple way of testing yourself from home and getting accurate results online. Taking the sample is very easy, too. After washing your hands, you can take a lancet and press it firmly against the skin of the selected area (usually the little finger). Wipe away the first drop of blood and fill the blood collection tube to the upper line. Then, secure the tube and gently turn it over five to ten times. Always remember to label your sample before sending it back in the test kit box.

You can also refer to the full instructions for the sample collection required for an MPV blood test.

Question 5

What is a normal mean platelet volume?

Accepted Answer

The normal value for the MPV is variable because it depends on the exact instrument employed to measure it. In adults, a normal MPV is usually considered to be around 7 to 13 femtolitres (fL); however, you should look for the reference range that your laboratory reports. A full blood count test taken with Vitall always includes the appropriate range for your age and gender. [1]

A normal MPV says a lot about platelet function and production. Most of the platelets have a normal size, which frequently means that there is a good response to bleeding and adequate clot formation. Usually, the MPV is inversely proportional to the platelet count; in other words, when platelets are too big, they tend to be fewer in number. However, this balance can be altered by some diseases. For correct interpretation, the MPV should be evaluated alongside the platelet count.[1]

Up to five per cent of platelets are naturally larger than average; these are young, recently produced platelets that will become smaller after a couple of days.[2] Considering they are a small portion of the total count, they do not influence the MPV.

Question 6

What causes a high MPV?

Accepted Answer

A high MPV is usually caused by increased platelet destruction or consumption, which is evidenced by a low platelet count. A high platelet count associated with a high MPV is a very rare finding; therefore, it does not have a solid relation to any particular disorder. Some conditions commonly associated with a high MPV include:


	Immune thrombocytopenic purpura.[1]
	Infections, such as malaria, dengue fever, and visceral leishmaniasis.[4]
	Sepsis.[10]
	Disseminated intravascular coagulation.[10]
	Living at a high altitude.[11]
	Smoking.[12]
	Conditions with low-grade systemic inflammation, such as psoriasis, Beh&ccedil;et's disease, and ankylosing spondylitis.[12]
	Certain anti-inflammatory drugs (anti-TNF alpha drugs).[2]
	Certain types of cancer (colorectal, liver, gastric, pancreas, and thyroid cancer).[2]
	Inherited macrothrombocytopenia.[5]


The MPV may be elevated in other diseases, and scientists are linking this finding to vascular disease, as well as other non-vascular disorders. While the data is not conclusive, evidence suggests that a high MPV may be associated with a higher risk of complications after having a heart attack, stroke, or venous thromboembolism.[6][7]

If you have a high MPV and hypertension, diabetes, pre-eclampsia, or any condition that may increase your risk of clot formation, it would be wise to discuss it with your GP before jumping to conclusions.

Thrombocytopenia and a high MPV can be suspected if you present some of the following symptoms:


	Fatigue.
	Heavy menstruations.
	Easy bruising.
	Bloody or dark stools.
	Blood in the urine.
	Small red-purplish dots on the skin (petechiae).
	Enlarged spleen.

Question 7

What is considered a high MPV?

Accepted Answer

In general, the upper limit of MPV is around 13 fL. The exact reference ranges for the MPV can vary across different laboratories depending on the instrument utilised to analyse the sample;[1] therefore, the best thing to do is to check the reference ranges reported by the lab processing the test. When you take an MPV blood test with Vitall your results will always include the appropriate ranges for your age and gender.

If you have a high MPV, it usually means that your platelets are larger than normal. However, there are cases in which platelets have a normal size but are clumped together; this can be erroneously interpreted as &lsquo;large platelets&rsquo; by the analyser machine. To discard this possibility, laboratories will usually do a blood smear and look at it under a microscope; this way, platelets can be seen directly to check whether they are large or clumped together.[1]

A high MPV is not enough to make any diagnosis on its own. This finding should be correlated with your symptoms and other tests before reaching any conclusion.

Question 8

What does a high MPV mean?

Accepted Answer

A high MPV means that your platelets are larger than normal. Frequently, a high MPV is associated with low platelet counts, which may mean that your platelets are getting destroyed at a faster rate, and the bone marrow is producing bigger platelets.

Platelets tend to become more active as they grow larger. Therefore, large platelets are more likely to form unnecessary clots, which may lead to severe conditions and lethal complications.[10] Many studies have revealed that there may be a link between high MPV and heart attacks, strokes,[6] pulmonary embolisms[8], and other clot-related conditions; nevertheless, more data is required to confirm this risk.[6]

If you have a condition with high-grade systemic inflammation (such as systemic lupus erythematosus), you may present high MPVs sometime after beginning your treatment. This change occurs because an anti-inflammatory treatment will reduce the severity of inflammation your body is experiencing; low-grade systemic inflammation is commonly associated with a high MPV. You can check the level of inflammation in your body using a CRP test.[12]

Question 9

What causes a low MPV?

Accepted Answer

A low MPV is generally caused by two types of conditions: those that consume large platelets or those that impair bone marrow function and platelet production.[12]

The first case is characterised by disorders in which younger, larger and more active platelets are rapidly consumed; as a result, only the smaller ones are left in circulation. In the second case, the megakaryocytes or the bone marrow are impaired by disease or chemotherapy, which leads to lower platelet production; as newer platelets (which tend to be larger) are not produced, the MPV is lowered. A single condition may present one or both mechanisms to lower the MPV.[12]

Some relevant examples include:


	Aplastic anaemia.[4]
	High-grade systemic inflammation (rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease).[12]
	Cervical cancer.[2]
	Certain chemotherapeutics.[2]
	Genetic disorders, such as X-linked thrombocytopenia.[13]


Low MPV is commonly associated with some of the following symptoms, which may vary depending on its cause:


	Fatigue.
	Bleeding problems.
	Small red-purplish dots on the skin (petechiae).
	Painful joints or muscles.
	Frequent infections.
	Sleeping problems.
	Enlarged spleen.

Question 10

What is considered a low mean platelet volume?

Accepted Answer

While the exact reference value may differ between laboratories, a normal MPV should not be below 7 fL;[1] for the correct interpretation of the test, you should check your laboratory&rsquo;s MPV reference range.

The Vitall full blood count test will always include the appropriate MPV range for your age and gender, and will clearly indicate if your result is abnormal.

An MPV test is very inconclusive on its own and should be analysed alongside platelet count and other exams.

Question 11

What does a low MPV mean?

Accepted Answer

If you have a low MPV, it means that the size of your platelets is smaller than normal. Considering that large platelets are young and easily activated,[10] smaller ones are typically older and may underperform when they are required. Having cancer and a low MPV is often associated with a poor prognosis;[1] patients with haematological cancer, low platelet count, and low MPV may have an increased risk of bleeding.[5]

In certain situations, people with low-grade systemic inflammation (such as psoriasis) may present a low MPV if their condition worsens; this may result from increased inflammation, which often leads to low MPV.[12]

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