Total Leukocyte Count Depicting the Degree of Inflammation in 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 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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AN EVALUATION OF DIAGNOSTIC ACCURACY OF C-REACTIVE PROTEIN, TOTAL LEUKOCYTE COUNT, NEUTROPHIL COUNT AND ULTRASONOGRAPHY IN DIAGNOSIS OF ACUTE APPENDICITIS

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2017/1406 ◽

2017 ◽

Vol 6 (91) ◽

pp. 6470-6475

Author(s):

Umeshchandra D G ◽

Puneeth Thalasta

Keyword(s):

Acute Appendicitis ◽

Diagnostic Accuracy ◽

Neutrophil Count ◽

Leukocyte Count ◽

Total Leukocyte Count ◽

C Reactive Protein ◽

Reactive Protein

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Immune function during pregnancy varies between ecologically distinct populations

Evolution Medicine and Public Health ◽

10.1093/emph/eoaa022 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 114-128

Author(s):

Carmen Hové ◽

Benjamin C Trumble ◽

Amy S Anderson ◽

Jonathan Stieglitz ◽

Hillard Kaplan ◽

...

Keyword(s):

Leukocyte Count ◽

Total Leukocyte Count ◽

Future Research ◽

Differential Leukocyte Count ◽

Ecological Conditions ◽

Trade Offs ◽

The Usa ◽

Immunological Changes ◽

Fetal Antigens ◽

Pathogen Exposure

Abstract Background and objectives Among placental mammals, females undergo immunological shifts during pregnancy to accommodate the fetus (i.e. fetal tolerance). Fetal tolerance has primarily been characterized within post-industrial populations experiencing evolutionarily novel conditions (e.g. reduced pathogen exposure), which may shape maternal response to fetal antigens. This study investigates how ecological conditions affect maternal immune status during pregnancy by comparing the direction and magnitude of immunological changes associated with each trimester among the Tsimane (a subsistence population subjected to high pathogen load) and women in the USA. Methodology Data from the Tsimane Health and Life History Project (N = 935) and the National Health and Nutrition Examination Survey (N = 1395) were used to estimate population-specific effects of trimester on differential leukocyte count and C-reactive protein (CRP), a marker of systemic inflammation. Results In both populations, pregnancy was associated with increased neutrophil prevalence, reduced lymphocyte and eosinophil count and elevated CRP. Compared to their US counterparts, pregnant Tsimane women exhibited elevated lymphocyte and eosinophil counts, fewer neutrophils and monocytes and lower CRP. Total leukocyte count remained high and unchanged among pregnant Tsimane women while pregnant US women exhibited substantially elevated counts, resulting in overlapping leukocyte prevalence among all third-trimester individuals. Conclusions and implications Our findings indicate that ecological conditions shape non-pregnant immune baselines and the magnitude of immunological shifts during pregnancy via developmental constraints and current trade-offs. Future research should investigate how such flexibility impacts maternal health and disease susceptibility, particularly the degree to which chronic pathogen exposure might dampen inflammatory response to fetal antigens. Lay Summary This study compares immunological changes associated with pregnancy between the Tsimane (an Amazonian subsistence population) and individuals in the USA. Results suggest that while pregnancy enhances non-specific defenses and dampens both antigen-specific immunity and parasite/allergy response, ecological conditions strongly influence immune baselines and the magnitude of shifts during gestation.

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The mongolian gerbil: qualitative and quantitative aspects of the cellular blood picture

Laboratory Animals ◽

10.1258/002367775780957250 ◽

1975 ◽

Vol 9 (4) ◽

pp. 283-287 ◽

Cited By ~ 10

Author(s):

Walter G. Dillon ◽

Chester A. Glomski

Keyword(s):

Haemoglobin Level ◽

Cell Volume ◽

Mongolian Gerbil ◽

Leukocyte Count ◽

Absolute Number ◽

Total Leukocyte Count ◽

Red Cell ◽

Blood Picture ◽

Qualitative And Quantitative ◽

Circulating Lymphocytes

The gerbil displays sex determined differences in packed red-cell volume, haemoglobin level, total leukocyte count and absolute number of circulating lymphocytes. The erythrocytes demonstrate a prominent polychromasia and frequent occurrence of basophilic stippling.

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