Platelets are recognized to play vital roles in inflammatory and immunological responses. They are triggered by a variety of stimuli, and their activity is known to influence the immune-inflammatory process.1-2 Mean platelet volume (MPV) is a measure of the average size of the platelets. Platelet activity is measured by analyzing several platelet-derived secretory molecules, including coagulation factors, growth factors, adhesion proteins, cytokines and  chemokines.3 Furthermore, MPV and platelet distribution width (PDW) have been widely investigated and reported as platelet activation methods.4  Furthermore, MPV and PDW may be easily assessed by automated hematology analyzers, and these parameters are included in standard complete blood cell (CBC) analysis, and they are a cost-effective and convenient technique to monitor platelet activation in daily practice.5 MPV levels have been linked to a variety of disorders, including cardiovascular disease, rheumatoid arthritis (RA), systemic sclerosis, osteoarthritis, Alzheimer's disease, peripheral artery disease and  vascular dementia and so on .6  Psoriasis is a prevalent chronic recurring inflammatory skin condition that affects around 2-3% of individuals. The global frequency is estimated at 11.4% in adults & 1.4% in children. It may arise at any age & tends to include the skin and joints, significantly compromising quality of life. Additionally, it is linked to disorders including metabolic syndrome, cardiovascular disease and diabetes. Typically observed on extensor surfaces such as the elbows, scalp and knees, typical lesions are red, raised plaques with silvery scales.7 While the specific origin & pathophysiology of psoriasis remain unclear, immune dysregulation and inflammation are thought to be significant causes.  Platelets influence immunological and inflammatory pathways, in addition to their traditional responsibilities in coagulation and tissue repair, as per new study.8  When activated, they contact leukocytes and release various growth factors, chemokines, including cytokines. Platelet-mediated immune activation may cause the distinctive leukocyte infiltration observed in psoriatic skin.9 MPV measures platelet aggregation and activity. Automated hematology analyzers calculate MPV, which measures platelet size and function during a full blood count test. Platelets with higher MPV levels have denser granules and exhibit enhanced activity. Elevated MPV levels indicate increased platelet activation, which is linked to severity of the disease and cardiovascular risks. Individuals with psoriasis had an MPV value of 8.63 ± 0.67 fL.10 Elevated MPV levels in individuals with psoriasis may indicate a relationship between platelet activation and disease severity. 7Research on the link between MPV and psoriasis is inconclusive, and no local data is published for the Pakistani community. Therefor this study was conducted to determine mean platelet volume in patients of chronic plaque psoriasis.

The present cross-sectional study was carried out at MMC- General Hospital, Peshawar from October 2025 to March 2026 after getting approval from the ethical committee of the hospital. Individuals of both genders and different age groups (ranged 18–50 years) with clinically diagnosed chronic plaque psoriasis were included. Individuals who used anticoagulants, or other drugs affecting platelet function or with hematological disorders, diabetes mellitus, autoimmune disorders, hypertension, cardiovascular disease chronic kidney disease and chronic liver disease, were excluded. Patients were recruited using a non-probability consecutive sampling technique. The

sample size was calculated using the WHO sample size calculator. The required sample was 200.  Demographic features such as sex, age, duration of disease, PASI score and BMI was recorded using a structured proforma. From each participant 3ml blood were aseptically collected from venous conditions and analyzed immediately using an automated hematology analyzer for determination of MPV. The results were checked by a qualified pathologist. SPSS version 25 was used for data entry and analysis. Qualitative data were reported as frequencies and percentages, whereas quantitative variables were represented as mean ± standard deviation. Mean MPV was compared across groups using an independent sample t-test and a one-way ANOVA. A p-value <0.05 indicated statistical significance.

In the current study a total of 200 individuals with chronic plaque psoriasis were included out of which females were 108(54.0%) and males were 92(46.0%). the mean age of the study population was 33.39± 8.70 years (ranged 18-50 years). Most of the individual were in the age group 31–40 years 86(43.0%) followed by age group 21-30 58(29.0%) , 41-50  46(23.0%) and 20 or below 10(5.0%) respectively. The overall mean MPV was 8.63 ± 0.71 Fl, PASI score  13.80 ± 8.10, duration of disease 2.30 ± 1.02 months and the mean BMI was 27.20 ± 5.20 kg/m. 122 (61%) individuals were overweight and the most of the participants  had sever psoriasis 120(60%). 68(34.0%) of the study participants had  raised MPV. Table 1  In terms of gender, the mean MPV for men (n = 92) was 8.59 ± 0.70 fL, whereas the mean MPV for female particepents (n = 108) was somewhat higher at 8.66 ± 0.72 fL. Still, this variance was not statistically important (p = 0.36), implying that platelet activation as measured by MPV was similar in male and female patients. The participants aged ≤20 years had highest mean MPV (8.71 ± 0.66 fL), next being those aged 21-30 years (8.68 ± 0.71 fL), 31-40 years (8.64 ± 0.69 fL), & 41-50 years (8.57 ± 0.70 fL). Although there were small changes in MPV among age groups, they were not statistically noteworthy (p = 0.42). This implies that age had no significant effect on MPV levels in individuals with chronic plaque psoriasis. In terms of illness duration, patients with 1-3 months had a mean MPV of 8.62 ± 0.71 fL, whereas those with more than 3 months had a mean MPV of 8.67 ± 0.68 fL. The variation between the two groups was not considered meaningful (p = 0.74), demonstrating that psoriasis duration was not linked with changes in platelet volume. Participants with a BMI between 18-25 kg/m² had a mean MPV of 8.65 ± 0.68 fL, in contrast to those with a BMI beyond 25 kg/m² had a mean MPV of 8.61 ± 0.72 fL. The difference was small but not statistically significant (p = 0.69), indicating that BMI had no discernible influence on MPV in this research sample. Applying the Psoriasis Area & Severity Index (PASI), individuals with mild, moderate, and severe psoriasis had mean MPV values of 8.67 ± 0.73 fL, 8.58 ± 0.71 fL, and 8.63 ± 0.70 fL, respectively. These variances were not statistically notable (p = 0.81), implying that MPV did not change substantially with the increasing clinical manifestations of psoriasis as presented in table 2.

Psoriasis is a chronic inflammatory skin disorder that causes erythematous, well-defined, scaly, & indurated plaques on the body and scalp. It affects around 3.2 percent of the population. In India, the frequency is thought to be 0.8%, although there are few research from Pakistan. Disease severity varies by individual and might fluctuate over time. Genetic and environmental factors contribute to the disease's etiology and pathogenesis.10-11 Psoriasis is now recognized as a systemic illness that affects internal organ systems, resulting to increased morbidity and death. It was formerly assumed to be a skin-specific disease. Psoriasis patients are more likely to experience cardiovascular events, particularly those with severe disease or psoriatic arthritis .Psoriasis patients had accelerated atherosclerosis and thickened carotid intima and media .There is a higher risk of cerebrovascular accidents, peripheral vascular disease, and venous thromboembolism.12-13 Psoriasis has a complicated etiology that includes inflammation throughout the body. Platelets, among other blood cells, serve an important role. Platelet activation and aggregation contribute significantly to the emergence of atherosclerosis and thromboembolism.14 MPV measures the mean size of

platelets. Platelet indicators, including MPV and PDW, indicate platelet activity. Higher MPV increases the likelihood of cardiovascular events. Studies show that MPV levels are greater in psoriasis patients compared to healthy persons.15 This study was conducted to determine mean platelet volume in patients of chronic plaque psoriasis. A total of 200 individuals with chronic plaque psoriasis were included out of which females were 54.0% and males were 946.0%. The mean age of the study population was 33.39± 8.70 years. Similar pattern of demographic features were recorded from the study conducted by Kim et al in which female were more than males and the mean age was 31.40± 8.69 years.16 our study revealed that 34.0% of the study participants had raised MPV.these findings are similar to the study conducted by Khan et al17 in their raised MPV was 35% which support out findings.  In our study mean MPV was 8.63 ± 0.71 Fl. These findings are similar to the study carried out by Amna et al in which the mean MPV was f 8.66 ± 0.79 fL.18 Most individuals with psoriasis have increased platelet activation. Gasparyan et al. emphasized platelets' dual function in thrombosis and inflammation, as well as their role in immunological modulation. This statement support our study.19 In our study mean MPV was 8.63 ± 0.71 Fl. Aman et al. found an MPV prevalence of 8.63 ± 0.67 fL in a study of psoriasis patients in Pakistan, similar to our findings.20 We applied the Psoriasis Area & Severity Index (PASI), individuals with mild, moderate, and severe psoriasis had mean MPV values of 8.67 ± 0.73 fL, 8.58 ± 0.71 fL, and 8.63 ± 0.70 fL, respectively. These variances were not statistically notable (p = 0.81), implying that MPV did not change substantially with the increasing clinical manifestations of psoriasis. Our study findings are similar to the results of Liu et al they found that MPV is larger in psoriasis patients compared to controls, the correlation with PASI scores is weak and inconsistent.21However, numerous outcomes have been observed. Kılıç et al. discovered higher MPV levels in persons with psoriasis vulgaris and psoriatic arthritis, with a slight but substantial positive correlation with PASI scores.22 In a PRISMA-compliant meta-analysis, Li et al. revealed substantially increased MPV levels in psoriasis patients, suggesting it might be used as a supplementary indicator of systemic inflammation.23  In our study the mean duration of the disease was 2.30 ± 1.02 months, which may explain the variation in results. Khatun et al. discovered greater MPV in psoriasis, although their participants had a longer disease duration, which may have made systemic inflammatory markers more conspicuous.24 Ocak et al. argue that differences in laboratory equipment and standards for identifying "raised MPV" may lead to inter-study inconsistencies.25   In our study there were no significant connections among MPV & clinical or demographic characteristics such as age, sex, BMI, or duration of illness. Sener et al. observed no convincing connection between MPV and BMI, gender, and CRP in individuals with psoriasis.26   Excluding persons with concurrent diseases, such as diabetes and cardiovascular disease, may have decreased confounding and contributed to the absence of an association. Our study offers valuable insights from a Pakistani psoriasis cohort, highlighting the lack of local studies on MPV in this group. Our results are bolstered by using a validated severity evaluation (PASI) and carefully excluding possible confounders, such as long-term concurrent conditions. The cross-sectional design limits the ability to interpret causal relationships. The absence of a control group and participants' short illness duration may have hidden relationships that might be more obvious in comparative study or with prolonged disease progression.

Our study revealed that 34.0 % of individuals with chronic plaque psoriasis had raised mean platelet volume, with mean MPV of 8.63 ± 0.71 fL. Gender, age severity and duration of psoriasis was not significantly associated with raised mean platelet volume. Our results explored that MPV may indicate systemic inflammation, it may not appropriately assess the severity of psoriasis. To evaluate the therapeutic significance of MPV in psoriasis treatment longitudinal research with bigger cohorts are needed.

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