{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T14:16:53Z","timestamp":1788445013058,"version":"build-2803163510"},"reference-count":56,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/501100004748","name":"Mashhad University of Medical Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004748","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Appl Thromb Hemost"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Thrombotic thrombocytopenic purpura (TTP) is a life-threatening and rare thrombotic microangiopathy (TMA) described as severe thrombocytopenia, microangiopathic hemolytic anemia, and ischemic end-organ injury because of microvascular platelet-rich thrombi. Recent findings show inflammatory conditions such as infection and surgery can be triggers for TTP onset. The aim of this study was to evaluate the diagnostic performance and clinical relevance of hematological inflammatory indices (NLR, PLR, and HPR) in patients with thrombotic thrombocytopenic purpura compared with healthy controls.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This case-control study was conducted on 114 TTP patients (90 female and 24 male) and 115 healthy controls from January 2010 to December 2022 in Imam Reza Hospital, Mashhad, Iran. Immune cell counts, inflammatory parameters, and hematological markers including NLR, PLR, and HPR were calculated using the complete blood count at the time of diagnosis and after the treatment. Statistical analyses were conducted by MedCalc, IBM SPSS Statistics version 26 and GraphPad Prism version 9.5.0.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>\n                      The result showed that at the time of admission, systemic (70.2%), bleeding (40.4%), and renal (41.2%) symptoms were the most frequent, whereas a lower prevalence of neurological (22.8%) signs and symptoms was observed. White blood cell (WBC) and neutrophil counts were higher in TTP patients (WBC: p&lt; 0.001, neutrophil: p&lt;0.001), and conversely, platelet and lymphocyte counts were higher in the control group compared to TTP patients (platelets: p&lt;0.001, lymphocytes: p&lt;0.001). The indices analysis between the two groups revealed that NLR and HPR were significantly increased in TTP patients (p&lt;0.001), but PLR was significantly reduced in TTP patients (with the mean platelet count of 62.09 \u00b1 55.37\u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L) compared to the control group (with the mean platelet count of 236.82 \u00b1 43.19\u00d7 10\n                      <jats:sup>9<\/jats:sup>\n                      \/L) (p&lt;0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Elevated NLR and HPR, together with decreased PLR, were associated with TTP in this cohort and may offer adjunctive diagnostic value alongside established clinical criteria. Confirmation in larger, prospective studies will be important to define their place in routine practice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/10760296261474712","type":"journal-article","created":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:58:51Z","timestamp":1788184731000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Value of Hematological Inflammatory Indices (NLR, PLR, HPR) in Thrombotic Thrombocytopenic Purpura: A Case-Control Study"],"prefix":"10.1177","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-0967-6625","authenticated-orcid":false,"given":"Mohammad Reza","family":"Meghdadi","sequence":"first","affiliation":[{"name":"Mashhad University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1448-008X","authenticated-orcid":false,"given":"Seyed Nasser","family":"Hosseinian","sequence":"additional","affiliation":[{"name":"Mashhad University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3414-5019","authenticated-orcid":false,"given":"Mohammad Hossein","family":"Ahmadi","sequence":"additional","affiliation":[{"name":"Mashhad University of Medical Sciences"},{"name":"Mashhad University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4160-4161","authenticated-orcid":false,"given":"Mohammad Reza","family":"Keramati","sequence":"additional","affiliation":[{"name":"Mashhad University of Medical Sciences"},{"name":"Mashhad University of Medical Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,31]]},"reference":[{"key":"e_1_3_5_2_2","doi-asserted-by":"publisher","DOI":"10.1002\/rth2.12708"},{"key":"e_1_3_5_3_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp053024"},{"issue":"10","key":"e_1_3_5_4_2","first-page":"1181","article-title":"Pathophysiology of thrombotic thrombocytopenic purpura","volume":"130","author":"Sadler JE","year":"2017","unstructured":"Sadler JE. 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