Clinical Hematology Parameters

In Vitro Diagnostic (IVD) Hematology Parameters*

In vitro Diagnostic (IVD) hematology parameters can be used to aid in monitoring disease progression and treatment. From anemias to leukemias to sepsis, clinicians rely on IVD parameters to provide the best possible treatment for their patients.

MPV, MRV and MDW are regulatory-cleared IVD tests that provide information to aid in patient management.

Mean Platelet Volume
(MPV)

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Monocyte Distribution Width (MDW)

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Mean Reticulocyte Volume
(MRV)

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“The development of the Coulter Principle revolutionized blood counting and allowed the accurate and automated enumeration of blood cells. We remain dedicated to innovation—to improved workflow efficiency in the hematology laboratory and patient care.”

Elena Sukhacheva, Ph.D.

*In Vitro Diagnostic parameters. For use in In Vitro Diagnostic procedures.

Mean Platelet Volume (MPV)

What is the MPV Parameter?

Unlike platelet counts, which measure the number of circulating platelets, MPV measures the average size of platelets.

MPV is the average volume of individual platelets and is derived from the PLT histogram
MPV parameter is measured in triplicate from the three apertures on the analyzer, and voting is performed comparing data for all three apertures. Results are produced by averaging the parameters obtained from the apertures that are within the established statistical range
PLT count and MPV measurement include the application of sweep flow to prevent the recirculation of cells behind the aperture. The sweep flow is a steady stream of diluent that flows behind the RBC aperture during the sensing period, which prevents cells from re-entering the sensing zone and being counted as platelets
Enhanced Beckman Coulter Principle allows a reportable MPV, even for thrombocytopenic patients
Expressed in fL

How is MPV used?

Direct volume measurement for MPV provides additional information, allowing for better thrombocytopenia management^1–3
Extensive literature supports the clinical utility of MPV^4–9†

^†The MPV parameter is not standardized between instruments from different manufacturers. MPV values are not transferrable between studies if hematology analyzers from different vendors are used.^10–12

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Monocyte Distribution Width (MDW)

What is the MDW Parameter?

The MDW parameter reflects a change in the volume of circulating monocytes in response to pro-inflammatory signals from infectious organisms referred to as pathogen-associated molecular patterns (PAMPs). Importantly, the results of MDW are independent of monocytes subpopulation percentage. The MDW value can be assessed simultaneously with the WBC value to provide physicians additional information regarding a patient’s immune status in response to infection.^13–24

MDW is the quantitative measurement of the volume distribution of the monocyte population in the blood
MDW is elevated in early stages of bacterial, viral or fungal infections leading to risk of severe infection or sepsis
MDW is measured with VCS technology as part of the white blood cell (WBC) differential hematology analysis from K3EDTA or K2EDTA anticoagulated whole blood venous samples
Monocytes are key players of the innate immune response and activate the adaptive immune system. Functional plasticity and increased heterogeneity of monocytes in sepsis²⁵ leads to increased morphological variability, which can be detected with MDW
MDW is a proprietary, regulatory-cleared hematological biomarker

How is MDW used?

MDW values above the established cutoff, in association with other clinical information and diagnostic testing are intended for use with adult patients presented within the first 12 hours to the emergency department as an aid in identifying patients with risk of severe infection and sepsis
MDW results are automatically available as part of CBC-Diff with no impact to laboratory or emergency department workflow and with no additional tests to order
Abnormal MDW increases the probability that patients have sepsis or severe infection, while normal MDW results decrease the probability that patients have sepsis or severe infection

MDW values greater than 20.0 together with other laboratory findings and clinical information, aid in identifying patients with sepsis or at increased risk of developing sepsis within the first 12 hours of hospital admission.

MDW results greater than 20.0 should be interpreted in association with other clinical information and diagnostic testing as a proportion of patients without sepsis may have an elevated MDW value at baseline. MDW values less than or equal to 20.0 cannot rule out sepsis or the development of sepsis within 12 hours of hospital admission. The Early Sepsis Indicator should not be used as the sole basis to determine the absence of sepsis.

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Mean Reticulocyte Volume (MRV)

What is the MRV Parameter?

MRV represents the average volume of all reticulocytes.

MRV is measured with VCS technology and represents the average volume of all retic events
The combination of low-frequency current, high-frequency current and light- scattering technology provides abundant cell-by-cell information and includes 29 morphometric data points per cell
While cells are prepared for reticulocyte analysis, they are spherified, cleared from hemoglobin, and stabilized in strictly controlled osmotic and temperature conditions, allowing for precise MRV measurement
A proprietary multidimensional analytical algorithm on reticulocytes helps avoid interference with reticulocyte count and MRV measurement in the presence of RBCs with inclusions

How is MRV used?

Anemia assessment and differential diagnosis^26–35
As a screening tool for hereditary spherocytosis^26–31

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References:

1. Bowles KM, Cooke LJ, Richards EM, Baglin TP. Platelet size has diagnostic predictive value in patients with thrombocytopenia. Clin Lab Haematol. 2005;27(6):370-373. doi:10.1111/j.1365- 2257.2005.00726

2. Numbenjapon T, Mahapo N, Pornvipavee R, et al. A prospective evaluation of normal mean platelet volume in discriminating hyperdestructive thrombocytopenia from hypoproductive thrombocytopenia. Int J Lab Hematol. 2008;30(5):408-414. doi:10.1111/j.1751- 553X.2007.00969

3. Saran K, Vidya K, Seema K, Prasad A, Prakash J. Study of platelet indices and their role in evaluation of thrombocytopenia. J Family Med Prim Care. 2022;11(10):6236-6242. doi:10.4103/jfmpc.jfmpc_460_22

4. Rodriguez BAT, Johnson AD. Platelet Measurements and Type 2 Diabetes: Investigations in Two Population-Based Cohorts. Front Cardiovasc Med. 2020;7:118. doi:10.3389/fcvm.2020.00118

5. Zhu X, Cao Y, Lu P, et al. Evaluation of platelet indices as diagnostic biomarkers for colorectal cancer. Sci Rep. 2018;8(1):11814. doi:10.1038/s41598-018-29293

6. Sileshi B, Urgessa F, Wordofa M. A comparative study of hematological parameters between hypertensive and normotensive individuals in Harar, eastern Ethiopia. PLoS ONE. 2021;16(12):e0260751. doi:10.1371/journal.pone.0260751

7. Ding L, Sun L, Wang F, Zhu L, Zhang T, Hua F. Clinical significance of platelet volume and other platelet parameters in acute myocardial infarction and stable coronary artery disease. Arq Bras Cardiol. 2019;112(6):715-719. doi:10.5935/abc.20190058

8. Coskun A, Yavasoglu I, Sargin G, et al. The role of mean platelet volume in patients with non- specific abdominal pain in an emergency department. Prz Gastroenterol. 2015;10(3):156-159. doi:10.5114/pg.2015.49042

9. Bowles KM, Warner BA, Baglin TP. Platelet mass has prognostic value in patients with myelodysplastic syndromes. Br J Haematol. 2006;135(2):198-200. doi:10.1111/j.1365- 2141.2006.06246

10. Harrison P, Price J, Didembourg M, et al. Feasibility of a mean platelet volume standard: an international council for standardization in hematology (ICSH) inter-laboratory study. Platelets. 2022;33(8):1159-1167. doi:10.1080/09537104.2022.2060956

11. Harrison P, Goodall AH. Studies on Mean Platelet Volume (MPV) - New Editorial Policy. Platelets. 2016;27(7):605-606. doi:10.1080/09537104.2016.1225467

12. Beyan C, Beyan E. Were the measurements standardized sufficiently in published studies about mean platelet volume? Blood Coagul Fibrinolysis. 2017;28(3):234-236. doi:10.1097/MBC.0000000000000586

13. Riva G, Castellano S, Nasillo V, et al. Monocyte Distribution Width (MDW) as novel inflammatory marker with prognostic significance in COVID-19 patients. Sci Rep. 2021;11(1):12716. doi:10.1038/s41598-021-92236-6

14. Hossain R, Ayub S, Tarabichi Y. Monocyte distribution width adds prognostic value in detection of COVID-19 respiratory failure. Int J Lab Hematol. 2022;44(2):e64-e66. doi:10.1111/ijlh.13712

15. Malinovska A, Hinson JS, Badaki-Makun O, et al. Monocyte distribution width as part of a broad pragmatic sepsis screen in the emergency department. Journal of the American College of Emergency Physicians Open. 2022;3(2):e12679. doi:10.1002/emp2.12679

16. Piva E, Zuin J, Pelloso M, Tosato F, Fogar P, Plebani M. Monocyte distribution width (MDW) parameter as a sepsis indicator in intensive care units. Clin Chem Lab Med. 2021;59(7):1307- 1314. doi:10.1515/cclm-2021-0192

17. Hausfater P, Robert Boter N, Morales Indiano C, et al. Monocyte distribution width (MDW) performance as an early sepsis indicator in the emergency department: comparison with CRP and procalcitonin in a multicenter international European prospective study. Crit Care. 2021;25(1):227. doi:10.1186/s13054-021-03622-5

18. Woo A la, Oh DK, Park C-J, Hong S-B. Monocyte distribution width compared with C-reactive protein and procalcitonin for early sepsis detection in the emergency department. PLoS ONE. 2021;16(4):e0250101. doi:10.1371/journal.pone.0250101

19. Lin H-A, Lin S-F, Chang H-W, Lee Y-J, Chen R-J, Hou S-K. Clinical impact of monocyte distribution width and neutrophil-to-lymphocyte ratio for distinguishing COVID-19 and influenza from other upper respiratory tract infections: A pilot study. PLoS ONE. 2020;15(11):e0241262. doi:10.1371/journal.pone.0241262

20. Agnello L, Bivona G, Vidali M, et al. Monocyte distribution width (MDW) as a screening tool for sepsis in the Emergency Department. Clin Chem Lab Med. 2020;58(11):1951-1957. doi:10.1515/cclm-2020-0417

21. Marcos-Morales A, Barea-Mendoza JA, García-Fuentes C, et al. Elevated monocyte distribution width in trauma: An early cellular biomarker of organ dysfunction. Injury. 2022;53(3):959-965. doi:10.1016/j.injury.2021.11.026

22. Crouser ED, Parrillo JE, Seymour CW, et al. Monocyte Distribution Width: A Novel Indicator of Sepsis-2 and Sepsis-3 in High-Risk Emergency Department Patients. Crit Care Med. 2019;47(8):1018-1025. doi:10.1097/CCM.0000000000003799

23. Crouser ED, Parrillo JE, Seymour C, et al. Improved early detection of sepsis in the ED with a novel monocyte distribution width biomarker. Chest. 2017;152(3):518-526. doi:10.1016/j.chest.2017.05.039

24. Ognibene A, Lorubbio M, Magliocca P, et al. Elevated monocyte distribution width in COVID-19 patients: The contribution of the novel sepsis indicator. Clin Chim Acta. 2020;509:22-24. doi:10.1016/j.cca.2020.06.002

25. Shalova IN, Lim JY, Chittezhath M, et al. Human monocytes undergo functional re-programming during sepsis mediated by hypoxia-inducible factor-1α. Immunity. 2015;42(3):484-498. doi:10.1016/j.immuni.2015.02.001

26. Lazarova E, Pradier O, Cotton F, Gulbis B. Automated reticulocyte parameters for hereditary spherocytosis screening. Ann Hematol. 2014;93(11):1809-1818. doi:10.1007/s00277-014-2127-8

27. Nair SC, Arora N, Jain S, Inbakumar D, Mammen J, Sitaram U. Mean reticulocyte volume enhances the utility of red cell mean sphered cell volume in differentiating peripheral blood spherocytes of hereditary spherocytosis from other causes. Indian J Pathol Microbiol. 2015;58(3):307-309. doi:10.4103/0377-4929.162836

28. Xu Y, Yang W, Liao L, et al. Mean reticulocyte volume: a specific parameter to screen for hereditary spherocytosis. Eur J Haematol. 2016;96(2):170-174. doi:10.1111/ejh.12563

29. Liao L, Xu Y, Wei H, et al. Blood cell parameters for screening and diagnosis of hereditary spherocytosis. J Clin Lab Anal. 2019;33(4):e22844. doi:10.1002/jcla.22844

30. Wu Y, Liao L, Lin F. The diagnostic protocol for hereditary spherocytosis-2021 update. J Clin Lab Anal. 2021;35(12):e24034. doi:10.1002/jcla.24034

31. Arora RD, Dass J, Maydeo S, Arya V, Kotwal J, Bhargava M. Utility of mean sphered cell volume and mean reticulocyte volume for the diagnosis of hereditary spherocytosis. Hematology. 2018;23(7):413-416. doi:10.1080/10245332.2018.1423879

32. Crispin PJ, Sethna F, Andriolo K. Red cell and reticulocyte parameters for the detection of iron deficiency in pregnancy. Clin Lab. 2019;65(11). doi:10.7754/Clin.Lab.2019.190427

33. Rodrigues A, Ortega C, Santos L, et al. Clinical utility of Beckman-Coulter Gen’s reticulocyte analysis in the study of anemia of chronic disease (ACD). Lab Hematol. 2007;13(3):85-92. doi:10.1532/LH96.07007

34. Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell parameters useful in classification and treatment, how? Int J Lab Hematol. 2016;38 Suppl 1:123-132. doi:10.1111/ijlh.12500

35. Piva E, Brugnara C, Spolaore F, Plebani M. Clinical utility of reticulocyte parameters. Clin Lab Med. 2015;35(1):133-163. doi:10.1016/j.cll.2014.10.004

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Clinical Hematology Parameters

In Vitro Diagnostic (IVD) Hematology Parameters*

Mean Platelet Volume (MPV)

Monocyte Distribution Width (MDW)

Mean Reticulocyte Volume (MRV)

Mean Platelet Volume (MPV)

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Monocyte Distribution Width (MDW)

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Mean Reticulocyte Volume (MRV)

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Mean Platelet Volume
(MPV)

Mean Reticulocyte Volume
(MRV)