Role of Total Leukocyte Count in Diagnosis of Acute Appendicitis

Introduction: Acute appendicitis is a common surgical condition; yet its diagnosis can be elusive at times and missed diagnosis can lead to attendant complications of perforation and its sequelae. On the contrary, negative appendectomy subjects one to unnecessary surgery and its physiological and psychological consequences. Among the various available modalities of diagnosis of appendicitis, Ultrasonography(USG) is easily accessible, non invasive, less time consuming, low cost investigation no radiation hazards. So, USG is appropriate diagnostic modality in our country.Methods: This prospective observational study was carried out from January 2011 to June 2011, in the radiology department of Bir hospital. Total of 80 cases with clinical impression of acute appendicitis were enrolled. These patients underwent surgery for suspected acute appendicitis. Details of signs and symptoms, lab findings including Total Leukocyte count (TLC), Differential Leukocyte Count (DLC) and USG findings were recorded. Intra-operative and histopathology findings were also recorded. The findings were analyzed to assess accuracy of ultrasonography in acute appendicitis. Histopathological report was considered the goal standard.Results: A total of 93 cases clinically diagnosed as acute appendicitis were subjected for USG. Out of 93 cases, 80 cases underwent surgery. Among 80 cases, sonography showed acute appendicitis in 56 cases out of which 54 was proved by histopathology as well. However, ultrasonography was not able to detect appendicitis in 9 cases. The sensitivity and specificity of USG for acute appendicitis were 87.7% and 88.2% respectively. The positive and negative predictive values were 96.4% and 62.5% respectively. Overall negative appendectomy rate of 21.2% had been used a basis for decision making, the rate of error being 13.7%.Conclusion: Ultrasonography is a fairly accurate and safe modality in acute appendicitis. It can be useful in reducing negative appendectomy rate.

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Comparison of the use of neutrophil: lymphocyte count ratio (NLCR) to total leukocyte count in diagnosing appendicitis in adults with right iliac fossa pain

Journal of Society of Surgeons of Nepal ◽

10.3126/jssn.v21i2.24357 ◽

2018 ◽

Vol 21 (2) ◽

pp. 24-27

Author(s):

Rabindra K.C. ◽

Abhishek Bhattarai ◽

Rakshya Joshi ◽

Ashok Kharel ◽

Ishwar Iohani

Keyword(s):

Acute Appendicitis ◽

Lymphocyte Count ◽

Leukocyte Count ◽

Iliac Fossa ◽

Final Diagnosis ◽

University Teaching ◽

Total Leukocyte Count ◽

Count Ratio ◽

Right Iliac Fossa Pain ◽

Laboratory Investigations

Introduction: Diagnosis of acute appendicitis (AA) is purely based on history, examination and few laboratory investigations. However, it is often a perplexing diagnostic problem during the early stages of the disease. Failure to make an early diagnosis is a primary reason for morbidity and mortality. Elevated leukocyte count is one of the indicators of appendiceal inflammation in patients with right iliac fossa pain and most of the patients with acute appendicitis present with leucocytosis. Recently, it has been seen that the neutrophil: lymphocyte count ratio (NLCR) is a more sensitive marker than leukocytosis in patients with acute appendicitis. Method: This is a prospective observational study conducted over a period of one year in the department of surgery at the Tribhuvan University Teaching Hospital, from September 2013 to August 2014. The clinical diagnosis of Acute appendicitis was made by history and clinical examinations and laboratory investigations. Total leukocyte count (TLC) and NLCR of patients diagnosed as AA were measured and recorded in the pro forma. Histological diagnosis was taken as the final diagnosis. Results: A total of 106 patients were included in the study. Two third of the patients were male. Right iliac fossa tenderness was the most common sign. Ultrasound was able to diagnose acute appendicitis in 40.65% of the cases. NLCR> 3.5 was observed in 90.56% of patients with acute appendicitis, whereas 78.3% of patients had leukocytosis only. High NLCR (5.60) is associated with complicated AA. Conclusion: NLCR is a more sensitive laboratory parameter than TLC in patients with RIF pain to diagnose acute appendicitis. A high NLCR ratio has a high likelihood of a complicated AA.

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Role of Leukocyte Count, Neutrophil Percentage, and C-Reactive Protein in the Diagnosis of Acute Appendicitis in the Elderly

The American Surgeon ◽

10.1177/000313480507100414 ◽

2005 ◽

Vol 71 (4) ◽

pp. 344-347 ◽

Cited By ~ 10

Author(s):

Horng-Ren Yang ◽

Yu-Chun Wang ◽

Ping-Kuei Chung ◽

Wei-Kung Chen ◽

Long-Bin Jeng ◽

...

Keyword(s):

Acute Appendicitis ◽

Leukocyte Count ◽

Young Patients ◽

The Elderly ◽

C Reactive Protein ◽

Reactive Protein ◽

Neutrophil Percentage ◽

Significant Difference ◽

Leukocyte Counts

Leukocyte count, neutrophil percentage, and C-reactive protein (CRP) have been shown to give valuable information in the diagnosis of acute appendicitis. However, whether these laboratory tests have the same clinical applicability in the elderly as in young patients remains unclear. This retrospective study aimed to clarify the role of these tests in the diagnosis of acute appendicitis in patients aged 60 years or over. Eighty-five consecutive elderly patients underwent appendectomy for suspected acute appendicitis during a 30-month period. Histologically verified appendicitis was found in 77 of the 85 patients (90.6%). There was no significant difference in leukocyte counts or CRP values between patients with acute appendicitis and those with a normal appendix. The sensitivities of leukocyte count, neutrophil percentage, and CRP in the diagnosis of acute appendicitis were 71.4 per cent, 88.3 per cent, and 90 per cent, respectively, while the specificities were 37.5 per cent, 25 per cent, and 37.5 per cent, respectively. Of 77 patients with acute appendicitis, only two had all three tests simultaneously normal. In conclusion, patients with normal results in all three tests are highly unlikely to have acute appendicitis and should be evaluated with extra caution before surgery.

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Role of C-reactive Protein, Total Leukocyte count and Erythrocyte Sedimentation Rate as a Diagnostic and Prognostic Indicator in Maxillofacial Infections

Indian Journal of Contemporary Dentistry ◽

10.37506/ijocd.v9i2.16478 ◽

2021 ◽

Vol 9 (2) ◽

pp. 20-24

Author(s):

Sivakumar Beena ◽

Shaji Thomas ◽

Darpan Bhargava ◽

Suyash Dubey

Keyword(s):

Erythrocyte Sedimentation Rate ◽

Sedimentation Rate ◽

Leukocyte Count ◽

Surgical Care ◽

Prognostic Indicators ◽

Total Leukocyte Count ◽

C Reactive Protein ◽

Reactive Protein ◽

Erythrocyte Sedimentation

Purpose: The aim of this study was to evaluate the role of C-reactive protein (CRP), Total Leukocyte Count(TLC) and Erythrocyte Sedimentation Rate (ESR) levels as diagnostic and prognostic indicators in patientsdiagnosed with maxillofacial odontogenic infections.Materials and Methods: A prospective study was done among 30 patients with maxillofacial odontogenicinfections. Blood samples were collected at 3 intervals to detect the level of the study parameters followedby incision and drainage for all the patients under Local anesthesia.Results: The mean CRP, TLC and ESR levels gradually reduced on 5th post-operative day as compared today 1 and 3 suggestive of resolution of the infectious state.Conclusion: We conclude that CRP is required only in selective cases of maxillofacial infection wheremonitoring under intensive care will be required, else TLC alone is sufficient to indicate the presence ofinfection along with adequate medical and surgical care.

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Role of total leukocyte count and C-reactive protein in diagnosis of acute appendicitis

International Surgery Journal ◽

10.18203/2349-2902.isj20180446 ◽

2018 ◽

Vol 5 (3) ◽

pp. 883

Author(s):

Anuradha Dnyanmote ◽

Sagar Ramesh Ambre ◽

Foram Doshi ◽

Snehal Ambre

Keyword(s):

Acute Appendicitis ◽

Sensitivity And Specificity ◽

Leukocyte Count ◽

Total Leukocyte Count ◽

C Reactive Protein ◽

Reactive Protein ◽

Surgical Emergencies ◽

Group A ◽

Negative Appendicectomy ◽

Group B

Background: Acute appendicitis is still one of the most common surgical emergencies. This study was conducted to check the sensitivity and specificity of Total leukocyte count (TLC) and C Reactive Protein (CRP) of acute appendicitis. Aim and objectives were to check the sensitivity and specificity of total leukocyte count in diagnosis of acute appendicitis and to check the sensitivity and specificity of CRP in diagnosis of acute appendicitis. To determine TLC and CRP efficacy in diagnosis of acute appendicitis.Methods: TLC and CRP were calculated in all patients who were planned to undergo appendectomy. Appendectomies were performed independent of results of TLC and CRP levels. For statistical purpose the patients were assigned into 2 groups- Group-A Patients with inflamed/perforated/gangrenous appendix, Group-B patients with Normal appendix. The normal TLC and CRP values, raised TLC, raised CRP, and raised both TLC and CRP values calculated in each of these groups. Sensitivity and Specificity were calculated. The cut off value for TLC was 11x106/L. This value was selected arbitrarily as it corresponds to the elevated TLC. The CRP levels were calculated and cut off value was taken as 1.7mg/dl.Results: Out of 75 cases, 55 were male and 20 were female. Age ranged from 13 to 58 years. CRP was raised in 82.14% of inflamed appendix cases TLC was raised in 76.79% of inflamed appendix cases and both was raised in 92.5% of inflamed appendix cases.Conclusions: TLC and CRP are useful in diagnosis of acute appendicitis. Negative appendicectomy rate can be decreased.

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