High Total Leukocyte Count in the Diagnosis of Acute Appendicitis

Objectives: To establish the sensitivity and specificity of the white cell count using auto analyzer in patients presenting with acute appendicitis. Material and Methods: This cross sectional study was conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad; from March 2010 to February 2011. All adult patients with acute appendicitis undergoing emergency appendecectomy were included, while conservatively managed cases were not included. Informed consent was obtained from all the patients prior to inclusion in the study as a part of ethical practice. Patients were admitted through emergency.The data was collected regarding personal profile of the patient, detailed history, and thorough clinical examination; and relevant investigations were performed. TLC was calculated by auto analyser (SYSMEX® model SF-3000). Decision of operation was based purely on clinical grounds. Findings of histopathology (degree of inflammation of appendix as observed by the pathologist) were noted for final diagnosis (taken as gold standard). Data was analyzed on SPSS version 13.0. Chi square test was used to find any association of TLC (high, normal) with acute appendicitis (normal, mild, moderate and severe) at 5% level of significance. P value of <0.05 was considered statistically significant. Results: Results are based on data from 147 patients that underwent appendecectomy, including 82 males and 65 females. TLC was raised (above 11000/mm3)in 89 patients while 58 had TLC within normal range (below 11000/ mm3). Depending on operative findings, majority of the patients (68%, n=100) had markedly inflamed appendix while 45 (30.6%) had mildly inflamed and only two (1.4%) had normal looking appendix. On histopathological examination appendix was found to be acutely inflamed in 128 (87%) patients while 19 (13%) patients had negative appendicectomy. The raised TLC had a sensitivity of 64.8%, specificity 89.4%, positive predictive value 97.6%, negative predictive value 27.5%, and accuracy 68%. Conclusions: Raised total leukocyte count is found to be a useful diagnostic tool for the diagnosis of the acute appendicitis.It can be safely opted as a marker for the grading and status of appendicitis.