Acta Scientific Microbiology (ISSN: 2581-3226)

Research Article Volume 5 Issue 10

Evaluation of NLR and PLR in Immune Thrombocytopenic Purpura; Is it Worth Doing?

Aisha Arshad1, Samina Naz Mukry1* and Tahir Shamsi2

1Department of Transplant Immunology and Applied Microbiology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan

2Department of Clinical Haematology, National Institute of Blood Diseases and Bone Marrow Transplantation, Karachi, Pakistan

*Corresponding Author: Chamari M Hettiarachchi, Department of Chemistry, Faculty of Science, University of Colombo, Sri Lanka.

Received: July 29, 2022; Published: September 29, 2022

Abstract

Background: Immune thrombocytopenia (ITP) is an autoimmune disorder. The clinical biomarkers like Neutrophils to lymphocytes ratio (NLR) and platelet to lymphocytes ratio (PLR) can be used as differential diagnostic tool in ITP. The current study was planned to evaluate utility of NLR and PLR in ITP diagnosis and their association with disease prognosis and response to treatment.

Methods: A case control study (1:1) was conducted from January 2015 to December 2017 with 111 ITP patients and 111 healthy controls. Peripheral blood was collected and CBC were recorded using Sysmex XN-1000.The calculation of NLR and PLR was done using absolute value of neutrophils, lymphocytes and platelets counts. The significant difference (p = <0.05) between ITP patients and healthy control groups was determined by Kruskal wallis test, Dunn’s test and spearman’s correlation test was done to evaluate platelet count correlation with IPF using SPSS ver.23.

Results: Low hemoglobin and platelet counts with high total leucocyte count (TLC) and IPF were detected in ITP patients as compared to healthy individuals (p = <0.05).Among all groups of ITP patients, very low platelet count with median(IQR) of 2(3.8)x109/l was observed in ND-ITP group. The NLR was high with prognosis of disease as higher levels were observed in P-ITP. The PLR was significantly low in ND-ITP, P-ITP, C-ITP, R-ITP and compared to controls with p = <0.001.

 Conclusion: The simple, reliable and calculated NLR and PLR ratios can be used in predicting prognosis and response to treatment in ITP and to some extend the severity of disease

Keywords: Immune Thrombocytopenic Purpura (ITP); Neutrophils to Lymphocytes Ratio (NLR); Platelet to Lymphocytes Ratio (PLR); Immature Platelet Fraction (IPF)

References

  1. Di Paola JA and Buchanan GR. “Immune thrombocytopenic purpura”. Pediatric Clinics of North America5 (2002): 911-928.
  2. Sekhon SS and Roy V. “Thrombocytopenia in adults: A practical approach to evaluation and management”. South Medical Journal5 (2006): 491-498; quiz 9-500, 33.
  3. Kayal L., et al. “Idiopathic thrombocytopenic purpura”. Contemporary Clinical Dentistry 3 (2014): 410-414.
  4. Rodeghiero F., et al. “Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group”. Blood 11 (2009): 2386-2393.
  5. Neunert C., et al. “The American Society of Hematology 2011 evidence-based practice guideline for immune thrombocytopenia”. Blood 16 (2011): 4190-4207.
  6. Buttarello M and Plebani M. “Automated blood cell counts: state of the art”. American Journal of Clinical Pathology 1 (2008): 104-116.
  7. Imtiaz F., et al. “Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population”. International Archives of Medicine 1 (2012): 2.
  8. Lu H., et al. “Inflammation, a key event in cancer development”. Molecular Cancer Research 4 (2006): 221-233.
  9. Syed NN., et al. “Chronic ITP: analysis of various factors at presentation which predict failure to first line treatment and their response to second line therapy”. Journal of Pakistan Medical Association 3 (2007): 126-129.
  10. Tripathi AK., et al. “Megakaryocyte morphology and its impact in predicting response to steroid in immune thrombocytopenia”. Platelets 7 (2014): 526-531.
  11. Song W., et al. “Preoperative platelet lymphocyte ratio as independent predictors of prognosis in pancreatic cancer: A systematic review and meta-analysis”. PLoS One6 (2017): e0178762.
  12. Li B., et al. “Platelet-to-lymphocyte ratio in advanced cancer: review and meta-analysis”. Clinica Chimica Acta 483 (2018): 48-56.
  13. Balta S and Ozturk C. “The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events”. Platelets 7 (2015): 680-681.
  14. Cao Z., et al. “Prognostic role of haematological indices in sudden sensorineural hearing loss: Review and meta-analysis”. Clinica Chimica Acta 483 (2018): 104-111.
  15. Moulis G., et al. “Newly diagnosed immune thrombocytopenia adults: Clinical epidemiology, exposure to treatments, and evolution. Results of the CARMEN multicenter prospective cohort”. American Journal of Hematology6 (2017): 493-500.
  16. Bahoush G., et al. “Initial lymphocyte count in patients with acute immune thrombocytopenic purpura: Can it predict persistence of the disease?” Minerva Pediatrics (2014).
  17. Akbayram S., et al. “Initial Lymphocyte Count as Prognostic Indicator for Childhood Immune Thrombocytopenia”. Indian Journal of Hematology and Blood Transfusion 1 (2017): 93-96.
  18. Frederiksen H and Schmidt K. “The incidence of idiopathic thrombocytopenic purpura in adults increases with age”. Blood3 (1999): 909-913.
  19. Segal JB and Powe NR. “Prevalence of immune thrombocytopenia: analyses of administrative data”. The Journal of Thrombosis and Haemostasis 11 (2006): 2377-2383.
  20. Neylon AJ., et al. “Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients”. British Journal of Hematology 6 (2003): 966-974.
  21. Fahim NM and Monir E. “Functional role of CD4+CD25+ regulatory T cells and transforming growth factor-beta1 in childhood immune thrombocytopenic purpura”. Egypt Journal of Immunology1 (2006): 173-187.
  22. George JN., et al. “Idiopathic thrombocytopenic purpura: a practice guideline developed by explicit methods for the American Society of Hematology”. Blood1 (1996): 3-40.
  23. Talaat RM., et al. “Alterations in immune cell subsets and their cytokine secretion profile in childhood idiopathic thrombocytopenic purpura (ITP)”. Clinical and Experimental Immunology 2 (2014): 291-300.
  24. El-Rashedi FH., et al. “Study of CD4 (+), CD8 (+), and natural killer cells (CD16 (+), CD56 (+)) in children with immune thrombocytopenic purpura”. Hematology Oncology and Stem Cell Therapy 1 (2017): 8-14.
  25. Briggs C., et al. “Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia”. British Journal of Hematology 1 (2004): 93-99.
  26. Cho YG., et al. “[Clinical usefulness of the simple technique to diagnose thrombocytopenia using immature platelet fraction]”. Korean Journal of Laboratory Medicine 1 (2007): 1-6.
  27. Greene LA., et al. “Beyond the platelet count: immature platelet fraction and thromboelastometry correlate with bleeding in patients with immune thrombocytopenia”. British Journal of Hematology 4 (2014): 592-600.
  28. Eren R ÜM., et al. “Neutrophil Lymphocyte Ratio in Estimating Response to Corticosteroid Treatment in Immune Thrombocytopenia Patients”. Turkish Medical Journal1 (2019): 54-57.
  29. Li B., et al. “Platelet-to-lymphocyte ratio in advanced Cancer: Review and meta-analysis”. Clinica Chimica Acta 483 (2018): 48-56.
  30. Song J., et al. “Platelet-to-Lymphocyte Ratio (PLR) Is Associated with Immune Thrombocytopenia (ITP) Recurrence: A Retrospective Cohort Study”. Medical Science Monitor 25 (2019): 8683-8693.
  31. Wu Y., et al. “Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were associated with disease activity in patients with systemic lupus erythematosus”. International Immunopharmacology 2016/07/01/; 36 (2016): 94-99.
  32. Demircioglu S and Gürbüz A. “Determinants of recurrence in ITP treatment” (2020).

Citation

Citation: Samina Naz Mukry., et al. “Evaluation of NLR and PLR in Immune Thrombocytopenic Purpura; Is it Worth Doing?".Acta Scientific Microbiology 5.10 (2022): 24-30.

Copyright

Copyright: © 2022 Samina Naz Mukry., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.




Metrics

Acceptance rate30%
Acceptance to publication20-30 days

Indexed In






News and Events


  • Certification for Review
    Acta Scientific certifies the Editors/reviewers for their review done towards the assigned articles of the respective journals.
  • Submission Timeline for Upcoming Issue
    The last date for submission of articles for regular Issues is December 25, 2024.
  • Publication Certificate
    Authors will be issued a "Publication Certificate" as a mark of appreciation for publishing their work.
  • Best Article of the Issue
    The Editors will elect one Best Article after each issue release. The authors of this article will be provided with a certificate of "Best Article of the Issue"

Contact US