Diagnostic Utility of Platelet Indices in Differentiating Hypoproductive and Hyperdestructive Thrombocytopenia: A Cross-Sectional Study From North India.

BACKGROUND: Thrombocytopenia may result from either decreased platelet production (hypoproductive) or increased peripheral platelet destruction (hyperdestructive), and distinguishing between these mechanisms is essential for appropriate clinical management. Bone marrow examination remains the reference standard but is invasive and not always feasible. Platelet indices generated by automated hematology analyzers may provide a simple, non-invasive alternative for the initial evaluation of thrombocytopenia. METHODS: This hospital-based cross-sectional study included 150 patients with mild to moderate thrombocytopenia (platelet count 50-<150 × 10³/µL) attending a tertiary care teaching hospital in North India between 2024 and 2025. Platelet count, mean platelet volume (MPV), platelet distribution width (PDW), plateletcrit (PCT), and platelet large cell ratio (P-LCR) were measured using automated hematology analyzers. Patients were classified as having hyperdestructive (n = 114) or hypoproductive (n = 36) thrombocytopenia based on clinical evaluation and relevant laboratory investigations. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of platelet indices. RESULTS: MPV, PDW, PCT, and P-LCR were significantly higher in patients with hyperdestructive thrombocytopenia than in those with hypoproductive thrombocytopenia (all p < 0.01). PDW (AUC = 0.747) and MPV (AUC = 0.745) demonstrated the best diagnostic performance. MPV showed the highest specificity (83.3%) at a cut-off value of 12.15 fL, whereas PCT demonstrated the highest sensitivity (78.1%) but relatively low specificity (38.9%). Plateletcrit showed a moderate positive correlation with platelet count (r = 0.464, p < 0.001). CONCLUSIONS: MPV and PDW demonstrated good diagnostic performance in differentiating hyperdestructive from hypoproductive thrombocytopenia and may serve as useful adjunctive markers during the initial evaluation of thrombocytopenic patients. As routinely available parameters obtained from complete blood count analysis, these indices may support clinical decision-making when interpreted alongside clinical and laboratory findings. Further multicenter studies are needed to validate these findings and establish standardized diagnostic cut-off values.