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Leukocytosis in Appendicitis

Leukocytosis in Appendicitis. Anthony W. Rekito, MD July 15, 2003. The Question.

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Leukocytosis in Appendicitis

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  1. Leukocytosis in Appendicitis Anthony W. Rekito, MD July 15, 2003

  2. The Question • “The total white cell count is elevated in the majority of patients with acute appendicitis, and the frequency with which it is requested in patients suspected of having acute appendicitis suggests that those concerned with the early assessment of these patients consider it of value.” • Bolton JP, Craven ER, Croft RJ, et al. An assessment of the value of the white cell count in the management of suspected acute appendicitis. Brit J Surg 1975; 62: 906-908.

  3. WBC in Acute Appendicitis • 100 consecutive cases of pathologically proved appendicitis over an 18 month period • routine preoperative WBC count on each patient • WBC count ranged from 5,500 to 23,500 • 82% of patients had WBC > 10,000 • Lee PW. The Leucocyte Count in Acute Appendicitis. Brit J Surg 1973; 60:618.

  4. Value of the WBC Count • Prospective study of 100 consecutive patients • 51 underwent appendectomy and 46 had histologically proved acute appendicitis • 24 had elevated WBC, clinically diagnosed, and histologically proved • 36 had normal WBC, negative clinical diagnosis, and recovered spontaneously • Bolton JP, Craven ER, Croft RJ, et al. An assessment of the value of the white cell count in the management of suspected acute appendicitis. Brit J Surg 1975; 62: 906-908.

  5. Laboratory Aid • A prospective blinded study of 204 patients with the tentative diagnosis of acute appendicitis • 100 were operated on: 59 had appendicitis, 3 had other surgically correctable diseases, and 38 had a negative exploration • WBC count demonstrated the best sensitivity (83%) and the predictive value of a negative result (88%) • Dueholm S, Bagi P, Bud M. Laboratory aid in the diagnosis of acute appendicitis: a blinded, prospective trial concerning the diagnostic value of leukocyte count, neutrophil differential count, and C-reactive protein. Dis Colon Rectum 1989; 32: 855-9.

  6. A Critical Review • Retrospective analysis of 1,000 consecutive patients operated on from January 1963 to June 1973 • No significant difference in WBCs exists between the stages of appendicitis ( mean of 15,000) • WBC count in appendicitis and PID was statistically different from mesenteric adenitis, gastroenteritis, and abdominal pain of unknown cause • Lewis FR, Holcroft JW, Boey J, Dunphy JE. Appendicitis: a critical review of diagnosis and treatment in 1,000 cases. Arch Surg 1975; 110: 677-84.

  7. More Recent • Review article • “Although 70-90% of patients with acute appendicitis have an elevated leukocyte count, leukocytosis is also characteristic of several other acute abdominal and pelvic diseases and thus has poor specificity for the diagnosis of acute appendicitis.” • Paulson EK, Kalady MF, Pappas TN. Suspected Appendicitis. NEJM 2003; 348: 236-242.

  8. HUP ism • Order the test because an elevated WBC count is a marker of some inflammatory process. • However, a normal or low WBC count does not rule out acute appendicitis.

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