Chronically Elevated Mean Platelet Volume (MPV) and Associated Conditions

Introduction to MPV and Associated Conditions

In polycythemia vera, platelet abnormalities including altered size may be present alongside other hematologic changes, as noted by the Mayo Clinic Proceedings 1, 2

Complete blood count with review of platelet parameters should be the initial step in evaluation, according to Praxis Medical Insights: Practical Summaries of Clinical Guidelines 3
Serial measurements are more valuable than isolated readings to establish chronicity, as recommended by Praxis Medical Insights: Practical Summaries of Clinical Guidelines 3

Monitor for bleeding risk in patients with very high MPV and thrombocytopenia, as acquired von Willebrand disease may occur in certain conditions like polycythemia vera, as reported by the Mayo Clinic Proceedings 1, 2

In 22q11.2 deletion syndrome, mild to moderate thrombocytopenia with increased platelet volume is common, possibly related to heterozygosity of the GPIBB gene, according to Genetics in Medicine 4

The American Heart Association recommends daily aspirin therapy (75-325 mg per day) for patients with elevated MPV who have documented transient focal neurological events 5, 6, 7
For patients with polycythemia vera and elevated MPV, the National Comprehensive Cancer Network recommends aspirin (81-100 mg/day) with phlebotomy (to maintain hematocrit <45%) for low-risk disease, and cytoreductive therapy (hydroxyurea) in addition to aspirin and phlebotomy for high-risk disease 8, 9
The European Association for the Study of the Liver recommends anticoagulation at therapeutic dose for at least 6 months in patients with liver cirrhosis and portal vein thrombosis who have elevated MPV 10

The American Heart Association suggests that cessation of stimulants such as caffeine, alcohol, and cigarettes may help control symptoms in patients with elevated MPV and associated conditions, and encourages a normal lifestyle and regular exercise for most patients, especially those who are asymptomatic 5, 6

The American Heart Association recommends aspirin therapy (75-325 mg per day) for patients with elevated MPV who experience cerebral transient ischemic attacks, as well as for patients with elevated MPV and atrial fibrillation who are less than 65 years old without history of mitral regurgitation, hypertension, or heart failure 11
For patients with elevated MPV and history of stroke, warfarin therapy is recommended if they have mitral regurgitation, atrial fibrillation, or left atrial thrombus, according to the American College of Cardiology 11
The National Comprehensive Cancer Network recommends management of myeloproliferative disorders, such as cytoreductive therapy for polycythemia vera, for patients with elevated MPV and myeloproliferative disorders 12