Developing Localized Reference Intervals for Platelet Indices in South India

Togy Thomas Zacharia

SIMATS, Thandalam, Chennai, India.

Chithra Srinivasan

Department of Pathology, SIMATS, Thandalam, Chennai, India.

Riaz Marakkar

Department of Nursing, Government Nursing college, Ernakulam, India.

*Author to whom correspondence should be addressed.


Introduction: The Platelet Indices (PI) are part of the most frequently done tests in the hospital.  They are considered as biomarkers in  numerous systemic and metabolic diseases. But the real challenge has been to define the clinical cutoffs which enable management based on the  above parameters. So we tried to develop Reference Intervals(RI) for PIs to enable them for clinical use.

Aim: The aim of the study was to develop RIs for the PIs from ostensibly healthy adult males from the local population.

Materials and Methods: 123 healthy adult males between the age 18 to 64, were chosen after screening and their blood samples collected and examined on Sysmex XN1000 cell counter for the PIs.

Results: The mean values of Platelet Count (PC), Distribution width (PDW), Mean Platelet volume(MPV), Plateletcrit (PCT), Large cell Ratio(P-LCR), Immature Platelet Fraction(IPF) and Absolute Immature Platelet Number(AIPN) were 2.58x109/L, 12.3%, 10.2fl, 0.281%, 27.17%,0.682%, and 1551.4 cells. PDW showed a strong positive correlation with MPV (r = 0.937) and P- LCR (r = 0.949). The PLT showed a very strong positive correlation with PCT (r = 0.901). The linear regression analysis of the rest of the PIs with PLT showed an 81% strong predictability for PCT.

Conclusion: The sex specific, instrument specific, localized RIs developed the study was compared to other published studies World over. It was also compared to an Indian and other South Indian studies. It also offers an opportunity for institutions using this cell counter to make use of the above RIs in clinical situations.

Keywords: Platelet Indices, Reference Intervals, IPF, Sysmex XN1000

How to Cite

Zacharia, T. T., Srinivasan , C., & Marakkar, R. (2023). Developing Localized Reference Intervals for Platelet Indices in South India. UTTAR PRADESH JOURNAL OF ZOOLOGY, 44(22), 269–275.


Download data is not yet available.


Pogorzelska K, Krętowska A, Krawczuk-Rybak M, Sawicka-Żukowska M. Characteristics of platelet indices and their prognostic significance in selected medical condition–a systematic review. Advances in Medical Sciences. 2020 Sep 1;65(2): 310-5.

de Gonzalo-Calvo D, de Luxán-Delgado B, Rodríguez-González S, García-Macia M, Suárez FM, Solano JJ, Rodríguez-Colunga MJ, Coto-Montes A. Platelet distribution width is associated with 1-year all-cause mortality in the elderly population. Journal of Clinical Gerontology and Geriatrics. 2013 Mar 1;4(1):12-6.

Solberg HE. The IFCC recommendation on estimation of reference intervals. The RefVal program. Clinical Chemistry and Laboratory Medicine (CCLM). 2004 Jul 5;42(7):710-4.

Gnanadeepam S, Selvajyothi P, Sumathy M, Kuzhali S, Sujatha A. Determination of Reference Intervals for Platelet Parameters using Sysmex XN-1000 among South Indian Population. Journal of Clinical & Diagnostic Research. 2022 Sep 1;16(9).

Kunal S, Sushant V, Abhishek D, Preeti M, Shanaz K. Normal Ranges of Advanced Clinical Parameters on XN‐2000 and Transference of Reference Ranges from XE‐2100 to XN‐2000. Sysmex J Int. 2017; 27:1-7.

Yukari Koita, Yoko Okazaki, Satoshi Kikuma, Tomoe Yamashita, Yuri Minato, Keiichiro Nohara, Rie Nakai and Jun Saegusa,. A basic study of the XR series of automated hematology analyzers. Medical Examination, 2022; 71(4):657-666.

Ali U, Gibbs R, Knight G, Tsitsikas D. Sex-divided reference intervals for mean platelet volume, platelet large cell ratio and plateletcrit using the Sysmex XN-10 automated haematology analyzer in a UK population. Hematology, transfusion and cell therapy. 2019 Jun 10;41:153-7.

L. van Pelt J, Klatte S, Hwandih T, Barcaru A, Riphagen IJ, Linssen J, Bakker SJ. Reference intervals for Sysmex XN hematological parameters as assessed in the Dutch Lifelines cohort. Clinical Chemistry and Laboratory Medicine (CCLM). 2022 May 25;60(6):907-20.

Sachdev R, Tiwari AK, Goel S, Raina V, Sethi M. Establishing biological reference intervals for novel platelet parameters (immature platelet fraction, high immature platelet fraction, platelet distribution width, platelet large cell ratio, platelet-X, plateletcrit, and platelet distribution width) and their correlations among each other. Indian Journal of Pathology and Microbiology. 2014 Apr 1;57(2):231.

van der Linden N, Klinkenberg LJ, Meex SJ, Beckers EA, De Wit NC, Prinzen L. Immature platelet fraction measured on the S ysmex XN hemocytometer predicts thrombopoietic recovery after autologous stem cell transplantation. European Journal of Haematology. 2014 Aug;93(2):150-6.

Bat T, Leitman SF, Calvo KR, Chauvet D, Dunbar CE. Measurement of the absolute immature platelet number reflects marrow production and is not impacted by platelet transfusion. Transfusion. 2013 Jun;53(6):1201-4.

Chandrashekar V. Plateletcrit as a screening tool for detection of platelet quantitative disorders. Journal of Hematology. 2013 Jun 13;2(1):22-6.

Asha J, Baiju NM, Innah SJ, Rafi A, John BM. Comparison of platelet indices in dengue fever patients based on platelet transfusion: A prospective observational study in a tertiary care center. Asian Journal of Transfusion Science. 2023 Jan;17(1):21.

Budak YU, Polat M, Huysal K. The use of platelet indices, plateletcrit, mean platelet volume and platelet distribution width in emergency non-traumatic abdominal surgery: a systematic review. Biochemia medica. 2016 Jun 15;26(2):17.