الفهرس 
Acknowledgment
Myelodysplastic syndromesOnly 14 pages are availabe for public view
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Abstract
This work aimed to evaluate MPV and platelet mass index in patients with primary MDS and its relation torisk stratification of MDSaccording to IPSS-R, 2012.
This study included 51 patients diagnosed as myelodysplastic syndromes who were admitted toClinical Hematology Unit of Internal Medicine Department of Assiut University Hospitalduring the studyperiod from July 2013 to December 2014. The patient group was classified as 28 males (54.9%) and 23 females (45.1%) and their ages ranged from 17 - 71 years old. In addition to 20 healthy individuals served as control group. Then the patients subdivided into five risk groups according to IPSS-R for MDS as follows:
1- Very high risk group including 8 patients.
2- High risk group including 8 patients.
3- Intermediate risk group including 14 patients.
4- Low risk group including 14 patients.
5- Very low risk group including 8 patients.
All patients were subjected to:
1- Full history taking .
2- Thorough clinical examination.
To all patients and controls, the following investigations were performed:
1- Complete blood count.
-Mean platelet volume
-Platelet mass index (Platelet count×Mean platelet volume)
2- Liver function tests.
3- Renal function tests.
4- Abdominal ultrasound.
5- Bone marrow aspirate and biopsy if indicated.
6- Karyotyping.
Statistical methods:
Analysis of the data was performed and statistical analysis using the SPSS software (version 16).
Descriptive statistics: Mean, standard deviation and percentages were calculated.Test of significances; Student t-test was used to compare the mean difference between the two groups and Chi-square test was used to compare the difference in proportion between the two groups. A significant P value (*) was considered when it is < 0. 05.
Ethical Consideration:
Verbal or written consent form before starting the study. Confidentiality was assured for all patients.
The results of this study showed that:
According to IPSS-R ,out of 51 patients, 8 patients(15.7%) were in very high risk group , 8 patients(15.7%) were in high risk group, 14 patients (27.5%) were in intermediate risk group, 14 patients (27.5% ) were in low risk group and 7 patients (13.7%) were in very low risk group.
Out of 51 patients, 50 patients(98%) presented with anemic manifestations, 20 patients(39.2%) presented with bleeding episodes and 7 patients(13.7%) presented with fever.On examination, 50 patients(98%) had pallor, 4 patients(7.8%) had hepatomegaly, 11patients(21.6%) had splenomegaly and no one had enlarged lymph nodes.
There was a statistical significant increase of MPV and reticulocytic count in MDS patientswhen compared to control group with (P= 0.000and 0.000) respectively and there was a statistical significant decrease in WBC,ANC,Hgb,Hct, RBC, MCH, platelet count and platelet mass index in those patients when compared to the same group with (P = 0.001,0.006, 0.000, 0.000, 0.000, 0.013, 0.000 and 0.000)respectively while, there was no statistical significant difference of MCVin MDS patientswhen compared also to the same group with (P = 0.367).
Karyotyping ofMDS patients included in this study was normal in 47 patients (92.1%), with 5q deletion in 2 patients (3.9%), 11q deletion in 1 patient (1.96%) and complex abnormalities in 1 patient (1.96%).
There was no statistical significant difference as regards blood urea and serum creatinine levelsinMDS patients when compared to control group with (P= 0.206 and 0.321) respectively.
There was a statistical significant decrease in ALP,TP, total bilirubin andPCwhen compared to control group with (P = 0.001,0.000, 0.013and 0.028)respectively but, there was no statistical significant differences were obtained in comparing AST, ALT,albumin, PT, INR and APTT in MDS patientsand those in control group with (P = 0.450,0.146, 0.723,0.488,0.610 and0.710) respectively.
In very high risk group patients
Patients included in this group were 8, their ages were ranged from 20-60 years old and they were 7 males (87.5%) and 1 female(12.5%).
All patients in this group (100%)presented with anemic manifestations, 4 patients(50%) presented with bleeding episodes and 2 patients(25%) presented with fever. On examination, all of them(100%) had pallor, but no one had hepatomegaly, splenomegaly or enlarged lymph nodes.
There was a statistical significant increase of MPV and reticulocytic countofthis group when compared to control group with (P= 0.021and 0.006) respectively and there was a statistical significant decrease in WBC, ANC, Hgb, Hct, RBC, platelet count and platelet mass index in this group when compared to control group with (P = 0.006, 0.000, 0.000, 0.000, 0.000, 0.000 and 0.000) respectively.While, there was no statistical significant difference of MCV and MCH of this group when compared to control group with (P = 0.252and 0.332) respectively.
Karyotyping of this group was normal in 7 patients and with complex abnormalities in 1 patient and BM blasts was ranged from 11-18%.
There was a statistical significant decrease in ALPand total bilirubin when compared to control group with (P = 0.020 and 0.001) respectively,but there was no statistical significant difference of AST, ALT, TP, albumin, PT, PC,INR andAPTT in this group when compared to control group with (P = 0.798, 0.357, 0.609, 0.571, 0.282, 0.167, 0.918 and 0.878) respectively.
In high risk grouppatients
Patients included in this group were 8, their ages ranged from 17-70 years old and they were 6 males (75%) and 2 females(25%).
All patients in this group(100%) presented with anemic manifestations, 2 patients(25%) presented with bleeding episodesand no one presented with fever.On examination, all of them(100%)had pallor, 1 patient(12.5%) had hepatomegaly, 4 patients(50%)had splenomegaly and no one had enlarged lymph nodes.
There was a statistical significant increase of MCH, MPV and reticulocytic count in this groupwhen compared to control group with (P= 0.034, 0.027 and 0.000) respectively andthere was a statistical significant decrease in Hgb, Hct, RBC, platelet count and platelet mass index ofthe same group when compared to control group with (P = 0.000, 0.000, 0.000, 0.000 and 0.000) respectively. But,no statistically significant differenceswere obtained when comparingWBC, ANC and MCV in patients of the same group and those of control group with (P = 0.508,0.508 and 0.401) respectively.
There was a statistical significant increase in platelet mass index of this group when compared to very high risk group with (P = 0.002),whilethere was no statistical significant differenceof MPV of the same group when compared tovery high risk group with (P-value= 0.752).
Karyotyping of this group was normal in all patients.
Blasts in BM of this group which were ranged from 5-15%, on their comparison to blasts in BM of very high risk groups, there was no statistical significant difference with (P= 0.243).
There was a statistical significant decrease in TP and albumin of this group when compared to control groupwith (P= 0.012 and 0.047) respectively, while there was no statistical significant differencesas regards AST,ALT,ALP, total bilirubin, PT, PC, INR and APTTof the same groupwhen compared to control group with (P= 0.541, 0.125, 0.508, 0.167, 0.506, 0.412, 0.816 and 0.443) respectively.
In intermediate risk group patients
Our recent results revealed that patients included in this group were14, their ages ranged from 18-71 years old and they were 7 males (50%) and 7 females(50%).
All patientsin this group(100%)presented with anemic manifestations, 6 patients(42.9%) presented with bleeding episodes and 1 patient(7.1%) presented with fever. On examination, all of them(100%) had pallor, 1 patient(7.1%) had hepatomegaly, 1 patient(7.1%) had splenomegaly and no one had enlarged lymph nodes.
There was a statistical significant increase of MPV in this group when compared to control group with (P= 0.002) and there was a statistical significant decrease in WBC, ANC, Hgb, Hct, RBC, platelet count and platelet mass indexof the same group when compared to control group with (P = 0.002, 0.019, 0.000, 0.000, 0.000, 0.000 and 0.000) respectively. But, there was no statistical significant difference of MCV, MCH and reticulocytic count ofthe same group when compared to control group with (P = 0.806, 0.472and 0.326) respectively.
There was no statistical significant change in MPV and platelet mass index of this group when compared to very high and high risk groups with (P= 0.274 and 0.274) and (P = 0.088 and 0.219) respectively.
Karyotyping of this group was normal in 14 patients and with 5q deletion in 2 patients.
Blasts in BM of this group which were ranged from 0-4%, on their comparison to blasts in BM of very high and high risk groups, there was a statistical significant decrease with (P= 0.000, 0.000) respectively.
There was a statistical significant decrease in ALPand TP when compared to control groupwith (P = 0.002 and 0.000) respectively, while there was no statistical significant difference ofAST, ALT, albumin, total bilirubin ,PT, PC, INR and APTT of this group when compared to control group with (P = 0.687, 0.902, 0.549, 0.145, 0.739, 0.847, 0.322 and 0.916) respectively.
In low risk group patients
Patients included in this group were14, their ages ranged from 24-65 years old and they were 5 males (35.7%) and 9 females (64.3%).
Out of 14 patients in this group, 13 patients(92.9%)presented with anemic manifestations, 7 patients (50%) presented with bleeding episodes and 2 patients(14.3%) presented with fever. On examination, 13 patients(92.9%) had pallor, 1 patient(7.1%) had hepatomegaly, 5 patients(35.7%) had splenomegaly and no one had enlarged lymph nodes.
There was a statistical significant increase of MPVand reticulocytic count of this groupwhen compared to control group with (P= 0.000 and 0.009) respectively andthere was a statistical significant decrease in WBC, ANC, Hgb, Hct, RBC, MCH,platelet count and platelet mass index of the same group when compared to control group with (P = 0.006, 0.037, 0.000, 0.000, 0.000, 0.019, 0.000 and 0.003) respectively. But,there was no statistical significant difference of MCVof the same group when compared to control group with (P-value = 0.972) respectively.
There was a statistical significant increase in MPV of this group when compared to very high risk group with (P = 0.044),but there was no statistical significant difference when compared to high and intermediate risk groups with(P = 0.101 and 0.963) respectively.
There was a statistical significant increase in platelet mass index of this group when compared to very high and high risk groupswith (P = 0.004 and 0.024) respectively, but there was no statistical significant difference when compared to intermediate risk group with(P = 0.060).
Karyotyping of this group was normal in all patients.
Blasts in BM of this group which were ranged from 0-2%, on their comparison to blasts in BM of very high and high risk groups, there were a statistical significant decrease with (P= 0.000, 0.000) respectively. While, there was no statistical significant difference when compared to intermediate risk group with (P= 0.225)
There was a statistical significant decrease in ALP, TP and PCof this group when compared to control group with (P = 0.000, 0.000 and 0.002) respectively, but there was no statistical significant difference of AST, ALT, albumin, total bilirubin, PT, INR and APTT of the same group when compared to control group with (P = 0.551, 0.713, 0.751, 0.362, 0.099, 0.498 and 0.902) respectively.
In very low risk group patients
Patients included in this group were 7, their ages ranged from 18-68 years old and they were 3 males (42.9%) and 4 females (57.1%).
All patients in this group (100%)presented with anemic manifestations, 1 patient(14.3%) presented with bleeding episodes and 2 patients(28.6%) presented with fever. On examination, all of them(100%)had pallor, 1 patient(14.3%) had hepatomegaly, 1 patient(14.3%) had splenomegalyand no one had enlarged lymph nodes.
There was a statistical significant increase of MPV and reticulocytic count in this groupwhen compared to control group with (P= 0.001 and 0.002) respectively and there was a statistical significant decrease in WBC, ANC, Hgb, Hct, RBC, platelet count and platelet mass indexofthe same group when compared to control group with (P = 0.001, 0.280, 0.000, 0.000, 0.000, 0.001 and 0.060) respectively. But,there was no statistical significant difference of MCV and MCH of the same group when compared to control group with (P = 0.157 and 0.076) respectively.
There was a statistical significant increase in MPVof this group when compared to very high and high risk groupswith (P = 0.021 and 0.018)respectively, but there was no statistical significant difference when compared to intermediate and low risk groups with(P = 0.179 and 135) respectively.
There was a statistical significant increase in platelet mass index of this group when compared to very high, high and intermediate risk groups with (P = 0.001,0.005 and 0.017)respectively, but there was no statistical significant difference when compared to low risk group with(P-value = 0.412).
Karyotyping of this group was normal in 6 patients and 11q deletion in 1 patient.
Blasts in BM of this group which were ranged from 1-2%, on their comparison to blasts in BM of low risk groups, there was no statistical significant difference with (P= 0.185).
There was a statistical significant increase in AST and ALT of this group when compared to control group with (P= 0.010 and 0.004) respectively, while there was a statistical significant decrease in TP and PC of the same group when compared to control group with (P = 0.008 and 0.046) respectively. But, there was no statistical significant difference of ALP, albumin, total bilirubin, PT, INR and APTT of the same group when compared to control group with (P = 0.618, 0.654, 0.078, 0.760, 0.431 and 0.191) respectively.