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 ::  Introduction
 ::  Material and Methods
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Year : 1977  |  Volume : 23  |  Issue : 1  |  Page : 25-27

Significance of leucocyte count in the diagnosis of acute appendicitis

Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Correspondence Address:
S Sood
Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh
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Source of Support: None, Conflict of Interest: None

PMID: 615255

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 :: Abstract 

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/, 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

How to cite this URL:
Sood S, Katariya R N, Rao P G, Rao P. Significance of leucocyte count in the diagnosis of acute appendicitis. J Postgrad Med [serial online] 1977 [cited 2022 Aug 17];23:25-7. Available from:

 :: Introduction Top

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. [8] The leucocyte count is given some importance but its value in diagnosis of acute appen­dicitis is still unclear.

 :: Material and Methods Top

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.­ [2]

Similarly a neutrophil count in excess of 75% was considered abnormal in ac­cordance with standard text books of haematology.

 :: Results Top

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 Top

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. [2] 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 [3] also reported a significant leucocytosis in 84% of cases of acute ap­pendicitis with a relative increase in polymorphs of 88% cases. Smith [8] 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, [5] re­ported significant leucocytosis in a study of 300 cases of acute appendicitis in pati­ents above 60 years of age. Sasso et a1 [7] 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, [1] Thorbjar­narson and Leehr. [9] Lee [4] again reported a rise in leucocyte count in 82% of his cases with pathologically proved appendi­citis.

Raftery [6] has recently shown either an abnormal total or differential leucocyte count in 96% of his cases of acute appen­dicitis.

 :: References Top

1.Brickman, I. D., and Leon, W.: Acute appendicitis in childhood. Surgery 60: 1083-1089, 1966.  Back to cited text no. 1    
2.Hardison, C. S.: The leucocytic count JAMA, 204: 377, 1968.  Back to cited text no. 2    
3.Lansden, F. T.: Acute appendicitis in children. Am. J. Surg., 106: 938-942, 1963.  Back to cited text no. 3    
4.Lee, P. W. R.: The leucocyte count in acute appendicitis Brit. J. Surg., 60: 618, 1973.  Back to cited text no. 4    
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.  Back to cited text no. 5    
6.Raftery, A. T.: The value of leucocyte count in diagnosis of acute appendicitis. Brit. J. Surg. 63: 143-144, 1976.  Back to cited text no. 6    
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.  Back to cited text no. 7    
8.Smith, P. H.: The diagnosis of appendi­citis. Post. Grad. Med. 41, 2-5, 1965.  Back to cited text no. 8    
9.Thorbjarnarson, B., and Loehr, W.: Acute appendicitis in patients over the age of sixty. Surg., Gynec., Obst. 125: 1277­1280, 1967.  Back to cited text no. 9    


  [Table 1]


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