The neutrophil lymphocyte ratio may be useful inflammatory indicator before applying other expensive and invasive procedures.

Dear Editor,

We read with interest article the entitled “Relation between platelet indices and branch retinal vein occlusion (BRVO) in hypertensive patients” by Onder et al.[1] They aimed to evaluate MPV in BRVO. They reported that MPV was significantly higher in patients with BRVO. The ready availability of MPV measurements at no additional cost may encourage its wider use in clinical practice.

Retinal vein occlusion is the most common retinal vascular occlusive disorder and is usually associated with a variable amount of loss of vision. Generally, branch retinal vein occlusion (BRVO) tends to be considered as one disease which is not only incorrect, but also cause of most of the confusion on the subject. A complete blood count is a relatively routine, inexpensive, practical, and easy examination that supplies additional information. MPV is a widely used laboratory marker associated with platelet function based on inflammatory conditions and thrombosis.[2] Recently, increased levels of MPV were demonstrated in cerebrovascular disease, peripheral artery disease, stroke, malignancy, gastrointestinal diseases, atrial fibrillation,[3] all of that are associated endothelial dysfunction on the basis of inflammation.[4] The higher MPV values are mentioned to be a beneficial marker of higher thromboycte activity and have been found to be associated with inflammation in patients with thyroid and rheumatic diseases. Platelet parameters might be influenced by coronary risk factors including age, obesity, smoking, diabetes mellitus, hypertension, hyperlipidemia, metabolic syndrome, and deep vein thrombosis. Furthermore, MPV value was found to be also higher in chronic obstructive pulmonary disease and nonalcoholic hepatic disease patients compared with a control group. Therefore, it may be interesting if the authors[1] provided information about these conditions.

Finally, not only MPV, but also red cell distribution width, neutrophil lymphocyte (N/L) ratio,[5] plateletcrit, platelet lymphocyte (P/L) ratio, C-reactive protein (CRP), gamma-glutamyl transferase (GGT), and uric acid are easy methods to evaluate the BRVO in hypertensive patients. These markers might be useful in clinical practice. We suggest that MPV ought to be evaluated together with other serum inflammatory markers such as N/L ratio, P/L ratio, GGT and uric acid.