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Elevated AST and MPV. No fever, blood disorders or anaemia. Any reason?

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General & Family Physician
Practicing since : 2009
Answered : 590 Questions
I have a question about elevated MPV on a routine CBC. Everything was within normal range, except for slightly elevated AST, and an MPV near the high end of the reference range at 12.1. (The range for the test at my hospital was 9-13). I was feeling pretty good until I read some articles online which showed a rather disturbing association of elevated MPV with multiple cardiovascular and cerebrovascular events, including infarction, fibrillation, and even sudden death. Oddly enough, the risks become significant, (1.2X) at an MPV of 8.0, less than the lower end of the reference range on my test! By the time MPV reaches my level, (12.1) studies show a 1.8X increased risk for all morbidities studied in the patient cohort. I'm pretty good with statistics, and this study seemed well-designed with a very large smple population of patients admitted to hospital in Australia. I'm very healthy, exercise regulary, feel great, and have never suffered from any serious conditions, but reading these studies makes me feel like a ticking time bomb. Should I double the amount on my life insurance policy, or is there something I'm not taking into consideration here?
Posted Sun, 7 Jul 2013 in X-ray, Lab tests and Scans
Answered by Dr. Yogesh D 7 hours later

Thank you for posting your query to me.

Let me put in a small disclaimer before I go further, "I am not a qualified cardiologist, I am a general practitioner only, and my answer may not be very comprehensive due to my limited knowledge as well as the very recent nature of the scientific discoveries that are related to your query". I will try to be as honest as possible while discussing the issue at hand will also give you my personal opinion and suggestions, but I request you to kindly followup with your cardiologist.

Based on the information provided by you in your query, I presume that you have read many scientific articles on the subject of MPV(mean platelet volume) and its correlation with acute coronary syndromes and coronary accidents. So I am compelled to think that you might be knowing more than me in this regard.

As the recent scientific studies illustrate, there is a significant or should I say compelling evidence that an increase in the mean platelet volume (MPV) in patients with unstable as well as stable angina increases the risk of acute coronary events.

As you also rightly noted, the statistics sounds very good indeed along with the study methods and protocols followed.

These are indeed very well designed studies with very clear observations.

But, the silver lining is this, The correlation of individually increased MPV in healthy people was not well made in any of those studies, but going by the strength of correlation in the studies that were conducted we may assume that it would have a significant impact even on asymptomatic or healthy individuals such as yourself.

The recommended course of action would be to get an angiographic coronary filling patterns done along with a routine treadmill, electrocardiogram and echo-cardiography to rule out any incidental slowing of the flow in the coronary arteries.

The best way to not to get a heart attack is by not worrying yourself into one, I advice you let go of the fears, this condition can be well managed by taking a dose of aspirin prophylacticaly, this knowledge helps in deciding who will benefit most by a prophylactic aspirin therapy.

About the lower range of MPV, I suggest you forget that, because other studies better designed do not show an increased risk at those levels, and the results were standardized, which means some people had higher values while some had lower values.

Please also remember that the MPV can be raised in any acute illness, infections or bleeding.

You enjoy your life, doubling your insurance amount is your personal choice.

I would like to know what was the reason for this CBC? Did you have any fever or do you have any blood disorders or do you have any anemia?

Please do write back to me with the answers so that I can help you better.

Hope this helps you. Please do let me know if I haven't addressed any of your concerns.

Awaiting your response.

Dr. Yogesh.D
Above answer was peer-reviewed by
Follow-up: Elevated AST and MPV. No fever, blood disorders or anaemia. Any reason? 12 hours later
Thanks, Dr. XXXXXXX your answers are helpful. As for the reason for the CBC, I was visiting my brother and his family, who are going through a difficult separation. The four days that I was down there was emotionally painful, and I began to have an unusual number of PVCs or "extra systoles". These, by themselves, did not bother me at first, since I've experienced them periodically since childhood, usually triggered by strong emotions or fatigue, too many cups of coffee, etc. I went to hospital to get checked out before boarding my flight home, just in case the unusual strength and frequency of the PVCs was symptomatic of a bigger problem. Along with the EKG, the doctor ordered the CBC, and they monitored my heart for about an hour. Since I don't feel comfortable in hospitals, I was in a state of physical anxiety the entire time, and my blood pressure was much higher than when I monitor it at home. My glucose level was also somewhat elevated, but they said that was not unexpected, given my situation. Everything else checked out OK, and the ER doctor only suggested that I consider drinking a bit less, since my AST was a few points above normal. The doctor said I was "cleared for takeoff" at that point. He said nothing about the MPV reading, (12 on a ref. range of 9-13). Incidentally, my WBC was 5.8 and platelet count was 161. All values were well within range on the diff. They did note that my CK was 146, within range, but calling for a CK-MB fraction, since my reading was >113 for a male. The result was a normal CK-MB fraction of 1.3 (Ref. 0.0-2.4) and no further testing was suggested by the lab results. I still experienced a fair numbers of PVCs on the trip home, but tried to relax, and within a couple days of returning, they abated, and I've no further symptoms. Since I've been diagnosed with glaucoma, I've had frequent visualization of my retinal blood vessels, and the opthamologist says they look healthy and clear. My sexual function/ability is also completely normal. I have never experienced chest pain, shortness of breath, or symptoms of PAD, and I work out pretty vigorously at times. I have no symptoms of arthritis or other inflammatory conditions. I hope this isn't too much information, but I think that's about it.
Oh yes, in answer to your original question, doctor: I've had no fever, blood disorders or anemia, at least to my knowledge. Also, no known family history of cardiovascular disease or other heritable conditions.
Answered by Dr. Yogesh D 6 hours later
Hello again Mr. XXXXXXX

Thank you very much for writing back with all these details and I really appreciate your attention to details, this indeed is helpful.

I have gone through your history completely, extra systoles can be triggered by strong emotions, too much caffeine and fatigue too as you have rightly described.

You answers to all the questions raised by me are a no, and you don't have any history of inflammatory conditions nor do you have any family history of cardiovascular diseases.

Keeping all of this in mind, I don't think you have any higher risk of developing a cardiac disease just because you had Platelet volumes raised on a single occasion.

I suggest you repeat this test and see how it is doing. If it remains elevated, then you could start aspirin if your cardiologist approves of it.

At this time I don't think there is anything to be worried about, you need to relax and let go of the fears, internet though a wonderful thing, quite often can be XXXXXXX by providing you information which is not appropriate.

I suggest you take it easy and get a CBC repeated, along with that if you are still worried and can't get this thing out of your head, can go for treadmill test and coronary angiogram and flow rate analysis to see if there is any slowing of coronary blood flow, but only if the repeat Mean Platelet Volumes are more than 12fml.

The stress you went through at your brother's place could well be the reason for the finding, so repeat it and if it has come down to normal, then you can forget about it for another 6 months, you might want to repeat MPV every six months once.

I hope this clarifies your doubts further. Do let me know if I haven't addressed any of your concerns.

Wishing you good health and a good day.

Warm regards.
Dr. Yogesh.
Above answer was peer-reviewed by
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