Platelets, 2012; Early Online:1–5 ß 2012 Informa UK Ltd. ISSN 0953-7104 print/ISSN 1369-1635 online DOI: 10.3109/09537104.2012.701029 ORIGINAL ARTICLE Mean platelet volume in acute rheumatic fever Ahmet Sert, Ebru Aypar & Dursun Odabas Department of Pediatric Cardiology, Konya Training and Research Hospital, Konya, Turkey Abstract Acute rheumatic fever (ARF) is still an endemic disease, especially among school-aged children in developing countries. Mean platelet volume (MPV), which is commonly used as a measure of platelet size, indicates the rate of platelet production and platelet activation. We aimed to investigate MPV in children with ARF. The study population consisted of 40 children with ARF (32 patients with carditis and 8 patients without carditis) and 40 healthy control subjects. White blood cell (WBC) and platelet counts were significantly higher and MPV values were significantly lower in patients with ARF during the acute stage when compared to controls. Erythrocyte sedimentation rate (ESR) and C-reactive protein values significantly decreased in patients with ARF after the treatment when compared to baseline, whereas MPV values increased. MPV values were negatively correlated with ESR and WBC, and platelet counts. In conclusion, during the acute stage of ARF, MPV values were lower when compared to controls. Keywords: Acute rheumatic fever, carditis, mean platelet volume Introduction Acute rheumatic fever (ARF) is still an endemic disease, especially among school-aged children in developing countries [1]. ARF is a delayed immunologically mediated autoimmune sequela of throat infection by group A -hemolytic strepto- cocci. It is a multisystem inflammatory disease that can affect different tissues including synovial joints and cardiac valves [2]. Cytokines, as the products of host response to inflamma- tion, play an important role in the defense against infections. Recently, it has been shown that inflammatory cytokines may play a pathogenic role in ARF [3]. Mean platelet volume (MPV), which is commonly used as a measure of platelet size, indicates the rate of platelet production and platelet activation [4]. Previously, MPV values have been studied in patients with hypertension, rheumatoid arthritis (RA), familial Mediterranean fever, paroxysmal atrial fibrillation, diabetes mellitus, obesity as well as during acute coronary syndrome and myocardial infarction [5]. To the best of our knowledge, MPV values have not previously been assessed in patients with ARF. We aimed to investigate the MPV values in patients with ARF during the acute stage and after anti-inflammatory treatment and com- pared results with healthy control subjects. Materials and methods Study population Data of all children who were hospitalized with the diagnosis of ARF during the acute stage in pediatric cardiology unit between February 2010 and February 2012 were reviewed. The patients were considered eligible for participation if the following criterion was met: diagnosis of ARF based on the revised Jones criteria during the acute stage of carditis [6]. The following data were collected by using a computerized patient database: complete blood count including white blood cell (WBC), platelet counts, MPV, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) values at the time of diagnosis and eight weeks of the treatment for children with ARF. The diagnosis of carditis was made by the presence of murmurs suggestive of valvular regurgitation and by echocar- diographic examinations. The World Health Organization Expert Committee specified four criteria of mitral and aortic regurgitant jets to differentiate normal from pathologic regurgitation on echocardiography: regurgitant jet should be 1 cm in length, seen in at least two planes, have a peak velocity 2.5 m/s, and should persist throughout the systole (mitral valve) or diastole (aortic valve) [7]. None of the patients were taking any medications (such as oral anticoagulants, aspirin, or nonsteroidal anti-inflammatory drugs) that might have caused platelet or coagulation abnor- malities during the last eight weeks before blood sampling. Patients with abnormal liver or renal function tests, myelo- proliferative disorders, or malignancies were excluded. Thirty- two of the 40 ARF patients had carditis, 24/32 of them had mild-to-moderate carditis, and the remaining 8/32 patients had severe carditis. Patients with arthritis and mild-to-moderate carditis were treated by salicylate, whereas patients with severe carditis were treated by oral prednisolone. Seven patients with moderate carditis who were unresponsive to salicylate therapy were also treated with oral prednisolone. A total of 15 of the 40 patients were treated with oral prednisolone. Initially, prednisone (2mg/kg/day) was given for approximately two weeks, then tapered and aspirin was given 80–100 mg/kg/day (doses as high as 3.5 g/day) Correspondence: A. Sert, Department of Pediatric Cardiology, Konya Training and Research Hospital, 42080 Konya, Turkey. Tel: þ 90 332 323 67 09. Fax: þ 90 332 323 6723. E-mail: ahmetsert2@hotmail.com (Received 11 May 2012; revised 1 June 2012; accepted 5 June 2012) Platelets Downloaded from informahealthcare.com by Hacettepe Univ. on 10/13/12 For personal use only.