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[anthonypaulh]

IN PLATELETS AGE and SIZE REALLY DOES MATTER

All of us purple people know that ITP is a condition where, even though our platelet production is increased from our bone marrow, our misguided immune system destroys platelets even more rapidly hence leading to thrombocytopenia and the tell tale symptoms we all recognise. 

Right so far are you with me ? OK…. well we have also discovered that in general and I say the words again to emphasise the point..IN GENERAL, we folk with ITP do not have the same bleeding tendency as those with the same degree of thrombocytopenia caused by a bone marrow issue/problem. 

So we purple folk in general don’t tend to bleed as much as those with bone marrow/platelet production issues. Our problem is one of destruction rather than production (in general terms). Also the platelet count in us purple people is actually a poor predictor of whether or not we are actually likely to suffer any bleeding be it internal (brain bleeds or internal organs) or external (nose bleeds, gum bleeds etc).

So what does all this mean ? In a nutshell in ITP because we are having to produce so many more platelets because our misfiring immune systems keeps destroying them it means a much higher proportion of our platelets are YOUNG. Well so what one might say ? Well so good actually. Younger platelets are more capable of stopping bleeding than older ones and this may explain the general tendency for less bleeding in ITP patients than those with platelet production/bone marrow deficiencies.

So in platelets the younger the better and so platelet age really is a definite factor. But it’s not just about age, it’s also a size issue too. Platelets decrease in size as they get older so the younger platelets are bigger and are therefore more effective in the clotting process. 

Now there is a test which can be done to measure the average size of our platelets called the Mean Platelet Volume (MPV). It takes into account the different sizes of platelet circulating in our blood. So if the younger platelets are more predominant our MPV will be greater but if the number of younger platelets is fewer our MPV will be lower. 

It is as if the ITP Gods have granted us a back handed bonus, a compensatory gift of younger, bigger more efficient platelets in exchange for mistakenly destroying them. One heck of a quid pro quo !

In ITP sufferers our MPV is normally higher than average  (again I use the words normally higher with caution) . Now this measure should not be looked at in isolation and cannot be relied upon in itself BUT it can be viewed at in combination with other evidence/symptoms that the patient is showing. 

Just to get a bit more complicated here is another set of initials to get thinking about in respect of the age of our platelets…. IPF which stands for Immature Platelet Fraction. This looks at the number of young platelets circulating in our blood system and it can give an indication of whether or not there is a likelihood that even with a low platelet count there is likely to be bleeding or not. 

With IPF and MPV all this is just another aspect of estimating/predicting whether or not the patient is at risk from bleeding or at least getting a better idea of the bleeding propensity.

So what can we conclude about the age of our platelets ? 

1. In general YOUNG platelets are more plentiful in ITP sufferers because we produce more of them to replace those being destroyed by our misfiring immune systems.

2. YOUNG platelets tend to be bigger and therefore are more efficient in the clotting process.

3. Testing can be done in the lab to check the volume of YOUNGER platelets and age of them in our systems. Hence it gives more information to our specialists when they consider whether or not we each have a greater or lesser propensity to bleed even with lower platelet counts.

4. This is an area still developing all the time and we are getting more ammunition to be able to design treatments specifically for patients as individuals. 

5. Age and Size really does matter with platelets.

As we are discovering more about our illness we are hopeful to better tailor treatments to the individual sufferer with more precision .