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|Year : 1977 | Volume
| Issue : 1 | Page : 25-27
Significance of leucocyte count in the diagnosis of acute appendicitis
S Sood, RN Katariya, PG Rao, PLNG Rao
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
Source of Support: None, Conflict of Interest: None
Leucocyte count was estimated in 220 suspected cases of acute appendicitis. The significance of white cell count in 192 cases of pathologically proved appendicitis is reported. It is suggested that the routine leucocyte count, a simple and non-time consuming investigation, is valuable in the assessment of a possible case of acute appendicitis. It is further stressed that although a white cell count below 10,000/cu.mm, does not exclude the possibility of acute appendicitis as seen in the present study, (false low count 7.9% false high 5.4%,) , such a value should prompt further review and consideration of diagnosis and it appears that correlation of physical signs with leucocyte count would carry more meaning than either of them alone.
|How to cite this article:|
Sood S, Katariya R N, Rao P G, Rao P. Significance of leucocyte count in the diagnosis of acute appendicitis. J Postgrad Med 1977;23:25-7
| :: Introduction|| |
Acute appendicits, though one of the commonest surgical emergencies, does not have any confirmatory diagnostic procedures in the form of haematological, biochemical or radiological tests. We have tried to rely mainly upon symptoms and clinical signs which at times can be extremely varied and misleading and may be mimicked by other conditions.  The leucocyte count is given some importance but its value in diagnosis of acute appendicitis is still unclear.
| :: Material and Methods|| |
220 patients admitted to the emergency services of Postgraduate Institute hospital during the year 1974 to June 1976 with a provisional diagnosis of acute appendicitis were studied, Rountine total white cell counts were performed in all of them using an improved Neubeuer counter and differential counts made by counting 100 consecutive cells in a stained blood film. In patients with minimal physical signs or patients who waited a period of observation, the counts were repeated prior to taking them up for surgery. The histological confirmation of diagnosis was obtained in all the operated specimens irrespective of whether the appendix appeared grossly inflammed at the time of surgery. As 95% of population have a white cell count of between 5,000-10,000/ cumm, a count in excess of this was recorded as abnormal. 
Similarly a neutrophil count in excess of 75% was considered abnormal in accordance with standard text books of haematology.
| :: Results|| |
The age of these 220 patients ranged between 14-55 years with a male female ratio of 4: 1. The white cell count ranged, between 4,000-30,000/Cumm. 203 patients were operated upon and rest 17 were treated conservatively. The distribution of leucocyte count in these patients is given in [Table 1].
192 patients of operated group had pathologically proved appendicitis out of which 176 (86.7%) revealed high total white cell count or increased neutrophils. The remaining 16 patients (7.9%) had normal total or differential leucocyte count. 11 patients (5.4%) who had again high total or differential white cell count did not turn out to be acute appendicits at surgery or histopathologically. The distribution of disease in these 11 patients was pathologically normal appendix-6, twisted overian cyst-2, mesenteric adenitis 2, perforated duodenal ulcer 1.
In the 17 patients treated conservatively 11 had normal counts and 6 high total white cell or neutrophil counts. The diagnosis in these 17 patients was salphingeoopheritis-3, responded to anti-amoebic therapy emperically 3, and 11 were discharged after initial period of observation.
Thus, increased counts were obtained in 86.7 % of cases of pathologically proved appendicitis. False normal counts were seen in 7.9% of cases of pathologically proved appendicitis and false high counts were observed in 5.4% of cases of proved not appendicitis. Hence out of 203 cases, 176 i.e. 86.7% are correctly diagnosed from leucocyte count and 27 cases i.e. 13.3% are not correctly diagnosed.
| :: Discussions|| |
Because of the wide variation in the range of the normal leucocyte count in healthy persons it is inevitable that overlap will occur between the leucocyte counts of a group of normal subjects and those of patients with acute appendicitis. However, 95% of the population have a leucocyte count of 5,000 to 10,000/cumm.  Thus, it was seen in the present study that great majority of the patients with acute appendicitis had significant rise in total or differential leucocyte count (86.7%).
Lansden  also reported a significant leucocytosis in 84% of cases of acute appendicitis with a relative increase in polymorphs of 88% cases. Smith  showed that of 30 cases of doubtful appendicitis, 20 had a leucocyte count greater than 10,000/cumm and confirmed appendicitis. Of the remaining 10, who had their count less than 10,000/cumm, 6 had acute appendicitis. Peltokallic and Jauhiainen,  reported significant leucocytosis in a study of 300 cases of acute appendicitis in patients above 60 years of age. Sasso et a1  in their study of 525 patients, showed leucocyte count of over 10,000/cumm in 90%, of cases. The degree of leucocytosis generally reflects the severity of inflamation in appendix. Similar was the experience of Brickmen and Leon, 1966,  Thorbjarnarson and Leehr.  Lee  again reported a rise in leucocyte count in 82% of his cases with pathologically proved appendicitis.
Raftery  has recently shown either an abnormal total or differential leucocyte count in 96% of his cases of acute appendicitis.
| :: References|| |
|1.||Brickman, I. D., and Leon, W.: Acute appendicitis in childhood. Surgery 60: 1083-1089, 1966. |
|2.||Hardison, C. S.: The leucocytic count JAMA, 204: 377, 1968. |
|3.||Lansden, F. T.: Acute appendicitis in children. Am. J. Surg., 106: 938-942, 1963. |
|4.||Lee, P. W. R.: The leucocyte count in acute appendicitis Brit. J. Surg., 60: 618, 1973. |
|5.||Peltokallio, P. and Jauhiainen. K.: Acute appendicitis in aged patients. Study of 300 cases after the age of 60. Arch. Surg., 100: 140-143, 1970. |
|6.||Raftery, A. T.: The value of leucocyte count in diagnosis of acute appendicitis. Brit. J. Surg. 63: 143-144, 1976. |
|7.||Sasso, R. D., Hanna, E. A. and Moore, D. L.: Leucocytic and Neutrophilic counts in acute appendicitis American J. Surg., 120: 563-566, 1970. |
|8.||Smith, P. H.: The diagnosis of appendicitis. Post. Grad. Med. 41, 2-5, 1965. |
|9.||Thorbjarnarson, B., and Loehr, W.: Acute appendicitis in patients over the age of sixty. Surg., Gynec., Obst. 125: 12771280, 1967. |