Study the relationship between nasal polyps, platelet count, mean platelet volume, neutrophil/lymphocyte ratio in patients attending otolaryngology OPD in a tertiary care teaching hospital, West Bengal

Manuprita Sharma, Santosh Raman, Bidhan Ray, Rupali Verma Bagga, Ramesh Kumar Sahu, Suajoy Kumar De


Background: Nasal obstruction is a common cause of marked nasal septal deviation. It is related strongly with hypoxia. Hypoxic conditions increase mean platelet volume levels. Many studies in literature point out that inflammation related to nasal polyp is mostly dependent on eosinophils and their inflammatory products. Beside eosinophils, platelets may have a role in nasal polyp development. Platelets are involved in hemostasis, tissue repairing and inflammation. Recently, mean platelet volume (MPV) was recognized as a simple inflammatory marker in the inflammatory disease. This study investigated the relationship of nasal polyps with MPV (mean platelet volume), platelet count and NLR (neutrophil to lymphocyte ratio).

Methods: The cross-sectional observational study we investigated CBC (complete blood count) parameters of the patients that consulted ENT clinic in a tertiary care teaching hospital, Haldia because of nasal polyp. About 76 patients and 42 controls were included in this study. In all groups, WBC (white blood cell count), RBC (red blood cell count), RDW (red cell distribution width), platelet count, MPV, PDW (platelet distribution width) and NLR parameters from CBC (complete blood count) were compared between patients and controls.  

Results: Mean WBC values were 6.89±1.33×103/μL in patients with NPs, vs. 7.11±2.32×103/μL in the control group. Mean haemoglobin (Hb) values were 13.19±1.34 g/dL in patients with NPs, vs. 14.1±1.67 g/dl in the control group. Mean MPV values were 9.11 ± 1.08 fL in patients with NPs, vs. 8.32±0.53 fL in the control group. Mean PLT values were 232.38 ± 39.97×103/μL in patients with NPs, vs. 271.44±45.14×103 in the control group. MPV was higher in nasal polyp patients, whereas platelet count was higher in controls. The difference was significant for the mean absolute neutrophil, platelet count, and lymphocyte counts, NLR, PDW and MPV values between the study group and the control group.

Conclusions: Platelet count and NLR were significantly lower in patients than the controls, whereas MPV was significantly higher in nasal polyp patients.


Nasal polyps, Controls, Mean platelet volume, Platelet count, White blood cell count, Neutrophil-to-lymphocyte ratio

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Newton JR, Ah-See KW. A review of nasal polyposis. Ther Clin Risk Manag. 2008;4(2):507-12.

Kahveci OK, Duran A, Miman MC. Our histopathological results for intranasal masses; retrospective study of 6 years. J Clin Anal Med 2012;3(3):289-92.

Bachert C, Gevaert P, Holtappels G, Cuvelier C, van Cauwenberge P. Nasal polyposis: from cytokines to growth. Am J Rhinol 2000;14:279-90.

Stamm AC, Draf W. Microendoscopic Surgery of Paranasal Sinuses and the Skull Base. New York: Springer; 2000.

Dempsey JA, Veasey SC, Morgan BJ, O'Donnell CP. Pathophysiology of sleep apnea. Physiol Rev 2010;90:47-112.

Drager LF, Togeiro SM, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: a cardiometabolic risk in obesity and the metabolic syndrome. J Am Coll Cardiol. 2013;62:569-76.

Karnath S, Blann AD, Lip GY. Platelet activation: assessment and quantification. Eur Heart J. 2001;22:1561-71.

Aktas G, Sit M, Tekce H, Alcelik A, Savli H, Simsek T, et al. Mean platelet volume in nasal polyps. West Indian Med J. 2013;62(6):515-8.

Diamantopoulos II, Jones NS, Lowe J. All nasal polyps need histological examination: an audit-based appraisal of clinical practice. J Laryngol Otol. 2000;114:755–9.

Dasgupta A, Ghosh RN, Mukherjee C. Nasal polyps: histopathologic spectrum. Indian J Otolaryngol Head Neck Surg. 1997;49:32–7.

Shulbha VS, Dayananda BS. Clinicopathological study of nasal polyps with special reference to mast cells in inflammatory polyps. Basic Appl Pathol. 2012;5:59–62.

Kanbay A, Tutar N, Kaya E, Buyukoglan H, Ozdogan N, Oymak FS, et al. Mean platelet volume in patients with obstructive sleep apnea syndrome and its relationship with cardiovascular diseases. Blood Coagul Fibrinolysis. 2013;24:532-6.

Karakaş MS, Altekin RE, Baktır AO, Küçük M, Cilli A, Yalçınkaya S. Association between mean platelet volume and severity of disease in patients with obstructive sleep apnea syndrome without risk factors for cardiovascular disease. Turk Kardiyol Dern Ars. 2013;41:14-20.

Chu SG, Becker RC, Berger PB, Bhatt DL, Eikelboom JW, Konkle B, et al. Mean platelet volume as a predictor of cardiovascular risk: a systematic review and metaanalysis. J Thromb Haemost. 2010;8:148-56.

Gasparyan AY, Ayvazyan L, Mikhailidis DP, Kitas GD. Mean platelet volume: a link between thrombosis and inflammation? Curr Pharm Des. 2011;17:47-58.

Vizioli L, Muscari S, Muscari A. The relationship of mean platelet volume with the risk and prognosis of cardiovascular diseases. Int J Clin Pract. 2009;63:1509-15.

Cengiz C, Erhan Y, Murat T, Ercan A, Ibrahim S, Ihsan G, et al. Values of mean platelet volume in patients with chronic tonsillitis and adenoid hypertrophy. Pak J Med Sci. 2013;29:569-72.

Tefferi A, Hanson CA, Inwards DJ. How to interpret and pursue an abnormal complete blood cell count in adults. Mayo Clin Proc. 2005;80:923–36.

Azab B, Bhatt VR, Phookan J, Murukutla S, Kohn N, Terjanian T, et al. Usefulness of the neutrophil to lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol. 2012;19:217–24.

Jung MR, Park YK, Jeong O, Seon JW, Ryu SY, Kim DY, et al. Elevated preoperative neutrophil to lymphocyte ratio predicts poor survival following resection in late stage gastric cancer. J Surg Oncol. 2011;104:504–10.

Uthamalingam S, Patvardhan EA, Subramanian S, Ahmed W, Martin W, Daley M, et al. Utility of the neutrophil to lymphocyte ratio in predicting long-term outcomes in acute decompensated heart failure. Am J Cardiol. 2011;107:433–8.

Bayram A, Yaflar M, Doan M, Güneri E, Özcan. Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio and mean platelet volume in patients with tinnitus. ENT Updates. 2015;5(3):103–6.

Turkmen K, Guney I, Yerlikaya FH, Tonbul HZ. The relationship between neutrophil-to-lymphocyte ratio and inflammation in end-stage renal disease patients. Ren Fail. 2012;34:155–9.

Sagit M, Cetinkaya S, Dogan M, Bayram A, Vurdem UE, et al. Mean platelet volume in patients with nasal polyposis. B-ENT. 2012;8:269-72.

Torun S, Tunc BD, Suvak B, Yildiz H, Tas A, Sayilir A, et al. Assessment of neutrophil-lymphocyte ratio in ulcerative colitis: a promising marker in predicting disease severity. Clin Res Hepatol Gastroenterol. 2012;36:491–7.

Romero AJ, Carbia CD, Ceballo MF, Diaz NB. Red cell distribution width (RDW): its use in the characterization of microcytic and hypochromic anemias. Medicina (B Aires). 1999;59:17-22.

Tonelli M, Sacks F, Arnold M, Moye L, Davis B, Pfeffer M. for the Cholesterol and Recurrent Events (CARE) Trial Investigators. Relation between red blood cell distribution width and cardiovascular event rate in people with coronary disease. Circulation. 2008;117:163-8.

Perlstein TS, Weuve J, Pfeffer MA, Beckman JA. Red blood cell distribution width and mortality risk in a community-based prospective cohort. Arch Intern Med. 2009;169:588-94.

Felker GM, Allen LA, Pocock SJ, Shaw LK, McMurray JJ, Pfeffer MA, et al. Red cell distribution width as a novel prognostic marker in heart failure: data from the CHARM Program and the Duke Databank. J Am Coll Cardiol. 2007;50:40-7.

Akil F, Yollu U, Turgut F, Ayral1 M. The Relationship Between Nasal Polyps, Mean Platelet Volume, Neutrophile/Lymphocyte Ratio and Platelet Count. Otolaryngol. 2016;6(4):140

Ulu S, Ulu MS, Bucak A, Kahveci OK, Yucedag F, et al. Evaluating the relationship between nasal obstruction and mean platelet volume by using acoustic rhinometry in patients with septum deviation. Rhinol. 2013;51:249-52.

Schoene NW. Design criteria: tests used to assess platelet function. Am J Clin Nutr. 1997;65:1665-85.

Huczek Z, Filipiak KJ, Kochman J, Michalak M, Roik M, et al. Baseline platelet size is increased in patients with acute coronary syndromes developing early stent thrombosis and predicts future residual platelet reactivity. A case-control study. Thromb Res. 2010;125:406-12.

Gigante J. Tonsillectomy and adenoidectomy. Pediatr Rev. 2005;26:199-202.

Drager LF, Polotsky VY, Lorenzi-Filho G. Obstructive sleep apnea: an emerging risk factor for atherosclerosis. Chest. 2011;140:534-42.

Li RC, Haribabu B, Mathis SP, Kim J, Gozal D. Leukotriene B4 receptor-1 mediates intermittent hypoxia induced atherogenesis. Am J Respir Crit Care Med. 2011;184:124-31.

Kent BD, Ryan S, McNicholas WT. Obstructive sleep apnea and inflammation: relationship to cardiovascular co-morbidity. Respir Physiol Neurobiol. 2011;178:475-81.

Kondo Y, Kuwahira I, Shimizu M, Nagai A, Iwamoto T, et al. Significant relationship between platelet activation and apnea-hypopnea index in patients with obstructive sleep apnea syndrome. Tokai J Exp Clin Med. 2011;36:79-83.

Ferroni P, Riondino S, Formica V, Cereda V, Tosetto L, Farina FL, et al. Venous thromboembolism risk prediction in ambulatory cancer patients: clinical significance of plate/lymphocyte ratio and platelet/lymphocyte ratio. Int J Cancer. 2015;136:1234–40.

Chung JH, Lim J, Jeong JH, Kim KR, Park CW, Lee SH. The significance of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio in vestibular neuritis. Laryngoscope. 2015;125:257–61.

Bucak A, Ulu S, Oruc S, Yucedag F, Tekin MS, Karakaya F, et al. Neutrophil-to-lymphocyte ratio as a novel-potential marker for predicting prognosis of Bell palsy. Laryngoscope. 2014;124:1678–81.

Seo YJ, Jeong JH, Choi JY, Moon IS. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio: novel markers for diagnosis and prognosis in patients with idiopathic sudden sensorineural hearing loss. Dis Markers. 2014;2014:702807.

Karli R, Alacam H, Unal R, Kucuk H, Aksoy A, Ayhan E. Mean platelet volume: is it a predictive parameter in the diagnosis of sudden sensorineural hearing loss? Indian J Otolaryngol Head Neck Surg. 2013;65:350–3.

Lee JH, Kwon KY, Yoon SY, Kim HS, Lim CS. Characteristics of platelet indices, neutrophil-to-lymphocyte ratio and erythrocyte sedimentation rate compared with C reactive protein in patients with cerebral infarction: a retrospective analysis of comparing haematological parameters and C reactive protein. BMJ Open. 2014;4:e006275.

Gökhan S, Ozhasenekler A, Mansur DH, Akil E, Ustündag M, et al. Neutrophil lymphocyte ratios in stroke subtypes and transient ischemic attack. Eur Rev Med Pharmacol Sci. 2013;17:653-7.

Verdoia M, Camaro C, Barbieri L, et al. Mean platelet volume and the risk of peri-procedural myocardial infarction in patients undergoing coronary angioplasty. Atherosclerosis 2013;228:136–41.

Greisenegger S, Endler G, Hsieh K, Tentschert S, Mannhalter C, Lalouschek W. Is elevated mean platelet volume associated with a worse outcome in patients with acute ischemic cerebrovascular events? Stroke. 2004;35:1688–91.

Han JS, Park TS, Cho SY, Joh JH, Ahn HJ. Increased mean platelet volume and mean platelet volume/platelet count ratio in Korean patients with deep vein thrombosis. Platelets. 2013;24:590–3.

Poorey VK, Thakur P. Effect of deviated nasal septum on mean platelet volume: a prospective study. Indian J Otolaryngol Head Neck Surg. 2014;66:437.