Platelet volume analysis for differential diagnosis of thrombocytosis

The results of the Coulter counter S plus II platelet volume analysis were studied in 100 patients with reactive thrombocytosis (platelet count greater than 500 X 10(9)/l), in 30 patients with myeloproliferative thrombocytosis, and in 32 patients with chronic myeloproliferative disease and a platelet count less than 500 X 10(9)/l. Patients with reactive thrombocytosis had considerably lower mean platelet volumes than those with myeloproliferative thrombocytosis, or normal subjects. The opposite was true for the platelet distribution width. This index for platelet heterogeneity was normal in reactive, but increased in myeloproliferative thrombocytosis. There were no differences in mean platelet volume or platelet distribution width between patients with myeloproliferative disease and a high or normal platelet count. The increased platelet heterogeneity in myeloproliferative disease was caused by an increase of both small and large platelets. The platelet distribution width seemed to be the best variable for the differential diagnosis of thrombocytosis. A platelet distribution width greater than 17 was found in 26 of the 30 patients with myeloproliferative thrombocytosis but in only five of the 100 patients with reactive thrombocytosis. A normal platelet distribution width in a patient with a high platelet count strongly suggests reactive thrombocytosis.