What is MPV?
An Overview of MPV
When your platelets are not working properly, you may have an increased risk of bleeding and bruising.
One way to determine this is by taking a mean platelet volume (MPV) test, which measures the average size of the platelets (thrombocytes) in your blood. If more platelets are being produced in the body, their average size will usually increase as well. This test can offer valuable insight into your overall platelet function and activity.
Platelets are tiny cell fragments that are formed from budding off of very large cells in the bone marrow called megakaryocytes .
Once platelets are in the bloodstream, they live for about 8 to 10 days and are then destroyed. Around one-third are stored in the spleen .
The main function of platelets is to keep us from bleeding excessively when we are injured. When you cut yourself, for example, platelets stick together to plug the site of injury. Other clotting factors are then recruited to the scene to prevent further bleeding .
But platelets are not just the “band-aids” of the circulatory system. Recent studies show that they also contribute to inflammation, defend against microbes, release growth factors to assist in wound healing, and help form new blood vessels .
Platelets come in different shapes and sizes. Newly produced platelets are usually larger and more active, while older platelets are smaller. Other factors that affect platelet size include [4, 5, 6, 3]:
- Thrombopoietin (TPO), the main hormone that controls platelet production. It boosts the production of megakaryocytes, cells that platelets are formed from
- Cytokines (IL-1, IL-3, IL-4, IL-6, IL-11, TNF), as MCV usually increases with inflammation
Also, when platelets are activated, they change from a disc-shaped cell into a spherical-shaped cell .
Under certain conditions, platelets are harmful, causing blood clots to form where they are not needed. Sometimes, clots will form inside blood vessels, restricting the flow of blood to tissues. Parts of these clots can also break off and travel through the bloodstream, where they lodge in the lungs, heart, and brain, causing severe damage and even death [8, 9].
A big factor in dangerous blood clot formation is platelet size. Larger platelets are more active and form more blood clots. Research has linked high mean platelet volume (MPV) to an increased risk of heart attacks and clots in the deep veins. MPV might even be a useful marker for heart disease [10, 11].
MPV Blood Test
An MPV test is typically included as part of a complete blood count (CBC) test, which assesses the overall composition of the blood and its individual components, such as red blood cells and white blood cells .
Since platelets become larger when the body is producing increased numbers of them, an MPV test is commonly used to determine problems with platelet production in the bone marrow or platelet destruction [13, 14].
Doctors usually compare the results of an MPV test to other platelet indices like the platelet count and the platelet distribution width (PDW) to gain more insight into the underlying causes of bleeding and bone marrow disorders.
MPV Normal Range
The normal range is 7-12 fL (fL= one femtoliter, a very small unit of blood).
Normal ranges vary among different labs.
A low MPV means platelets are smaller than average. In general, smaller platelets tend to be older, so a low MPV may mean that bone marrow is not producing enough new platelets.
However, a low MPV on its own is not informative enough and must be looked at with other tests to diagnose platelet diseases.
Causes of Low MPV
1. Bone Marrow Failure
Bone marrow hypoplasia is when the bone marrow — the soft spongy tissue that lies within the bones — contains very few blood cells. Low MPV is linked to bone marrow hypoplasia. New platelets are not produced by the bone marrow, so older, smaller platelets make up a larger proportion of all the platelets in the bloodstream .
2. Thrombocytosis (high platelet count)
Thrombocytosis is when the bone marrow produces excess platelets. Sometimes, the platelets are being produced faster than they can develop, so smaller-than-normal platelets build up .
Thrombocytosis can either be :
- Essential (primary): caused by a disorder of platelet-forming cells
- Reactive (secondary): caused by an underlying condition (i.e. blood loss, cancer, infections, iron deficiency, spleen removal, inflammation, surgery)
MPV was decreased both in 15 people with essential thrombocytosis and 89 people with reactive thrombocytosis in one study .
3. Iron Deficiency Anemia (IDA)
A lack of iron in the body can lead to reactive thrombocytosis, a disorder in which excess platelets are produced. These platelets are smaller than normal, which causes a decrease in mean platelet volume. Platelet count and size returns to normal after iron therapy [18, 1].
Iron deficiency anemia is caused by a lack of iron. Mean platelet volume was decreased in about 30% of women with this condition (n = 86) .
4. Certain Inflammatory Diseases
Some diseases specifically cause high-grade inflammation (such as familial Mediterranean fever and rheumatic fever) and are associated with low MPV. MPV levels go up over the course of anti-inflammatory therapy [3, 20].
5. HIV Infection
HIV impairs platelet production, resulting in an increased number of older, smaller platelets in the blood. A study in 234 HIV-infected women found that low MPV was associated with HIV infections .
6. Active Lupus
MPV was decreased in 36 people with active lupus disease. One reason may be the increased consumption of platelets at sites of inflammation .
Drugs that kill cells or reduce their division, such as chemotherapy drugs, can decrease MPV too .
Symptoms of Low MPV
- Pale skin
- Easy bruising
- Nosebleeds and bleeding gums
- Prolonged bleeding from cuts
- Shortness of breath
- Rapid and/or irregular heartbeat
- Frequent or prolonged infections
- Flu-like symptoms (e.g., fever, headache, muscle pain)
How to Increase MPV
1. Address any Underlying Conditions
- Iron deficiency anemia
- Familial Mediterranean fever and rheumatoid arthritis
- Bone marrow hyperplasia
- An HIV infection
- Active lupus
2. Consume More Iron-Rich Foods
3. Get Enough Vitamin B9 and Vitamin B12
A high MPV means that platelets are larger than average. Larger platelets are more reactive. This is sometimes a sign that the body is producing too many platelets .
Causes of High MPV
1. High Altitude
In a study of 401 people with sudden, reduced heart blood flow (acute coronary syndrome), MPV was higher in people living at high altitudes. This could be due to a rise in erythropoietin, a hormone that promotes the formation of red blood cells in the bone marrow. More erythropoietin is released at oxygen-poor high altitudes, which may increase MPV as well .
2. High Cholesterol Levels
High cholesterol levels increase platelet production. As a result, MPV rises because larger, newly-made platelets comprise the majority of all blood platelets. This is how high cholesterol may increase the risk of atherosclerosis, a hardening of the arteries and platelet buildup .
Platelet size was increased in eight people with high cholesterol levels .
In a study in 142 elderly people, smokers with risk factors for hardening of the arteries (atherosclerosis) had a higher MPV compared to nonsmoking and non-risk groups .
MPV was significantly higher in obese people compared to non-obese people. The higher the BMI the higher the MPV was in the obese group. These results suggest that high MPV may increase the risk of heart disease in people with obesity .
5. Vitamin D Deficiency
One study in 434 people found that low blood vitamin D levels were associated with high MPV .
6. Conditions with Increased Platelet Production
MPV increases in conditions with increased platelet production, as more young and large platelets, are circulating in the bloodstream.
The bone marrow stimulates platelet production in response to conditions trigger platelet destruction. In these cases, the platelet count is low but MPV is high. Conditions that destroy platelets and lead to a high MPV include [38, 39, 15, 40]:
- Idiopathic thrombocytopenic purpura, an immune disorder in which the blood doesn’t clot normally
- Disseminated intravascular coagulation (DIC), a condition in which blood clots form in small blood vessels throughout the body
- The onset of high blood pressure in pregnancy (pre-eclampsia)
- Myeloproliferative disorders, slow-growing blood cancers in which the bone marrow makes too many blood cells
MPV was higher in people with type 2 diabetes compared to non-diabetics (n = 416). Among people with diabetes, MPV was significantly higher in those with damage to the retina of the eyes (retinopathy) .
MPV is also associated with insulin resistance. In a study of 77 people with heart disease (coronary artery disease), MPV was higher in people who were also insulin-resistant compared to those sensitive to insulin .
8. Panic Disorder
People with anxiety and depression have an increased activity of the fight-or-flight, sympathetic nervous system, which can cause a higher MPV. In a study of 124 people, MPV was higher in people with panic disorder compared to healthy people .
9. Respiratory Diseases (pneumoconiosis)
Coal workers’ pneumoconiosis (CWP) is a lung disease caused by long term exposure to coal dust. Depending on its severity, the disease can be simple or complicated with progressive lung damage and scarring .
Reactive oxygen species (ROS) play an essential role in the development of this disease. ROS also activated platelets, which increases MPV. MPV was higher in miners with pneumoconiosis compared to miners and non-miners without it in a study of 299 retired coal miners .
10. Non-Alcoholic Fatty Liver Disease (NAFLD)
In a meta-analysis of 8 observational studies almost 1.5k people, MPV is much higher in people with non-alcoholic fatty liver disease. The reason is unclear, but the following factors may play a role :
- Inflammation, as platelets, can increase in size in response to chronic inflammation in people with this disease.
- Insulin resistance triggers an increase in MCV and is common in NAFLD patients.
11. Underactive Thyroid (hypothyroidism)
Subclinical hypothyroidism (SCH) is an early, mild form of an underactive thyroid (hypothyroidism). People with SCH may be more prone to increased platelet activation, which raises the risk of heart disease.
In a study of 60 people, blood triglycerides and MPV was significantly higher while HDL cholesterol levels were lower in those with SCH. Although MPV levels decreased after treatment, they remained higher than in those with normal thyroid function .
12. Overactive Thyroid (hyperthyroidism)
MPV was increased in 28 people with hyperthyroidism. After treatment, average MPV levels fell significantly .
13. Heart Disease
In a meta-analysis of 24 studies and over 6k, higher MPV was associated with :
- Heart attacks
- Death from heart attacks
- Gradual re-narrowing of the heart’s arteries even after surgery that widened them (angioplasty and stenting)
People with prosthetic heart valves have higher MPV and platelet activation. In a study of 168 patients, MPV was increased in all people with prosthetic heart valves (irrespective of whether they have additional blood clots in their heart valves) [50, 51].
14. Blood Vessel Inflammation
Behçet’s disease (BD) is a rare disease that causes blood vessel inflammation. MPV values were significantly higher in 36 people with this disease and linked to stiffness of the arteries .
When compared to healthy people, 24 stroke patients had higher MPV one day after stroke. After neurorehabilitative treatment, MPV levels decreased .
16. Blood Poisoning (sepsis)
MPV was elevated in 145 people with sepsis. Sepsis, or life-threatening blood poisoning as a result of an infection, may a result of :
- Increased blood clotting and platelet activation that can occur in the early phase of sepsis
- Destruction of platelets in sepsis, which causes increased platelet production
17. Chronic Myeloid Leukemia (CML)
Chronic myeloid leukemia (CML) is a rare type of cancer of the blood cells. Platelet production in this disease is abnormal and results in giant platelets. In one study of 58 patients with CML, MPV was higher in people with normal or higher platelet counts .
In a meta-analysis of 18 studies and ~3.5k people, MPV was significantly higher in people with malignant tumors than in healthy people and decreased after treatment .
Health Consequences of a High MPV
1. Diabetic Retinopathy
In a study of 192 diabetic patients, higher MPV increased the risk of damage to the retina of the eyes (retinopathy), a common complication of diabetes .
2. High Blood Pressure
3. Cancer Prognosis
In a study of about 500 colorectal cancer patients, people with increased MPV were less likely to survive compared to those with normal levels .
Symptoms of High MPV
Signs and symptoms depend on the underlying cause of the high MPV levels. They may include :
- Easy or excessive bruising (purpura)
- Superficial bleeding under the skin that appears as a rash of pinpoint-sized reddish-purple spots (petechiae), usually on the lower legs
- Prolonged bleeding from cuts
- Bleeding from your gums or nose
- Blood in urine or stools
How to Decrease MPV
1. Address Underlying Conditions
- Panic disorder
- Respiratory Diseases in coal workers (pneumoconiosis)
- Non-alcoholic fatty liver disease
- Hypo- and hyperthyroidism
- Heart disease
- Chronic Myeloid Leukemia (CML)
- Behcet’s Disease
2. Get Enough Vitamin D
Since vitamin D deficiency can cause a high MPV, consuming more fatty fish, like tuna, mackerel, and salmon, dairy products, cheese, and egg yolks may help lower MPV. Spending more time outdoors in the sun is the best way to boost vitamin D levels [37, 67].
3. Eat an Anti-inflammatory Diet
MPV is increased during inflammation. Reducing inflammation in the body by eating a diet rich in omega-6 and omega-3 fatty acids such as fats and oils, meat and poultry, grains, vegetables, nuts, and seeds may help reduce MPV [68, 69].
4. Lose Weight
5. Stop Smoking
Smoking increases MPV, while values drop after quitting .
6. Lower Blood Pressure
In one study of 36 people with high MPV recently diagnosed with slightly increased blood pressure, lifestyle changes for lowering high blood pressure such as reducing sodium intake, limiting alcohol, weight loss, and a healthy diet (DASH) also reduced MPV .
Genetics of MPV
The following genetic conditions are associated with abnormal MPV:
Gene Mutations and Low MPV
1. X-linked Thrombocytopenia
X-linked thrombocytopenia is a bleeding disorder that mostly affects men. It is caused by a mutation of the Wiskott-Aldrich Syndrome (WAS) gene, causing fewer and smaller platelets to be produced. It can lead to easy bruising, bloody diarrhea, or prolonged bleeding after minor injuries .
Gene Mutations and High MPV
1. Bernard Soulier Syndrome
Bernard-Soulier syndrome is a bleeding disorder associated with unusually large and few platelets. People with Bernard-Soulier syndrome may:
- Bruise easily and have an increased risk of nosebleeds
- Have abnormally heavy or prolonged bleeding following minor injury or surgery
- Experience spontaneous bleeding
- Have a rash of pinpoint-sized reddish-purple spots (petechiae)
- Experience heavy or prolonged menstrual periods (menorrhagia)
This syndrome is caused by mutations in one of three genes: GP1BA, GP1BB, or GPIX. These genes encode proteins that form a complex on the surface of platelets important for blood clotting (called glycoprotein Ib-IX-V). Mutations can lead to the absent or deficient expression of this complex, which impairs blood clotting [5, 72].
2. Gray Platelet Syndrome
Gray platelet syndrome is a rare genetic bleeding disorder characterized by large gray platelets and a low platelet count. Platelets appear gray because of low alpha granule content, sacs inside platelets that contain growth factors and other proteins essential for blood clotting [73, 5].
Gray platelet syndrome can be caused by mutations in the NBEAL2 gene, which disrupt the production of alpha-granules. Without alpha-granules, the normal platelets activity during blood clotting is impaired, increasing the risk of abnormal bleeding [74, 5, 73].
Symptoms of gray platelet syndrome include :
- Easy bruising
- Nosebleeds (epistaxis)
- Abnormally heavy or prolonged bleeding following surgery
- Irregular, heavy periods (menometrorrhagia).
3. Platelet Type vWD
Platelet-type von Willebrand disease (PT-VWD) is a rare genetic disorder characterized by prolonged bleeding time .
It is caused by a mutation within the GP1BA gene coding for a receptor on the platelets surface. This receptor binds a factor called VWF that helps platelets stick to the walls of blood vessels at the site of wounds. Mutations cause platelets to bind to VWF with much higher affinity, removing them from the blood, causing a low platelet count and increased risk of bleeding .
4. May Hegglin Anomaly
Around half of people with this disorder have no symptoms. The other half have :
- Low platelet count
- Nose bleeds
- Easy bruising
- Gum bleeding
- Heavy periods
- Excessive bleeding after surgeries
5. 21q11 Deletion Syndrome
The 22q11.2 deletion syndrome (22q11DS, also known as DiGeorge syndrome) is a disorder caused by the deletion of a small piece of chromosome 22 .
This syndrome has a wide variety of signs and symptoms that can affect nearly any part of the body, including :
- Heart defects
- Developmental delays
- Poor immune system function
- Cleft palate
Large platelets and a low platelet count are also frequent in people with this disorder, although they usually do not have bleeding problems .
Testing for MPV
- Lack of universal standardization
- Different machines used to measure MPV yield different results
- Lab procedures can affect the values (MPV may increase over time if EDTA is used to prevent coagulation of the blood sample)
Irregular MPV Levels?
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