From the Guidelines
Leukocytosis, or an elevated White Blood Cell (WBC) count, is a common finding in acute appendicitis, but its significance should be interpreted in the context of clinical presentation and other diagnostic markers, as it is not diagnostic on its own 1. Key points to consider:
- Normal WBC count does not rule out appendicitis
- Leukocytosis usually develops within 24-48 hours of symptom onset
- A left shift (increased immature neutrophils) is often present
- WBC counts >20,000 cells/μL may suggest perforation, as indicated by a study that found WBC count > 16,000 to be an independent predictor of perforation 1 In practice:
- Always consider clinical presentation alongside lab results
- Serial WBC counts can be helpful in unclear cases
- Combine with other markers like C-reactive protein for better accuracy It is essential to note that the diagnosis of acute appendicitis should not be based solely on elevated leukocytes count and CRP value, but rather should prompt an adequate diagnostic course, as recommended by the guidelines 1. The presence of leukocytosis in acute appendicitis is due to the body's inflammatory response to the infected appendix, and as bacteria multiply and inflammation progresses, more white blood cells are produced and released into the bloodstream to fight the infection 1. Given the potential for perforation and its consequences, especially in elderly patients, appendectomy should be performed as soon as possible once the operation is indicated, as suggested by the guidelines 1.
From the Research
Significance of Leukocytosis in Acute Appendicitis
- Leukocytosis, or an elevated White Blood Cell (WBC) count, is a common finding in patients with acute appendicitis 2.
- A raised total leukocyte count (TLC) is often used as an indicator of the degree of inflammation in acute appendicitis 2.
- However, a normal TLC does not rule out the diagnosis of acute appendicitis, as a substantial proportion of patients with normal TLC can still have acute appendicitis 2.
- The frequency of acute appendicitis in patients with normal TLC can be as high as 83.2% 2.
Diagnostic Challenges
- Acute appendicitis can be challenging to diagnose, as clinical signs or positive blood results can be absent in up to 55% of patients 3.
- A delay or mis-diagnosis of appendicitis can result in severe complications such as perforation, abscess formation, sepsis, and intra-abdominal adhesions 3.
- Leukocytosis can be a useful indicator of inflammation, but it is not specific to acute appendicitis and can be seen in other conditions as well 4.
Clinical Presentation
- Acute appendicitis typically presents with abdominal pain, nausea, vomiting, and fever 5, 6.
- Leukocytosis can be seen in patients with acute appendicitis, but it is not a universal finding 2.
- The diagnosis of acute appendicitis is often made based on a combination of clinical findings, laboratory tests, and imaging studies 5, 6, 3.
Management
- The management of acute appendicitis depends on the severity of the disease and the presence of complications 5, 6.
- Antibiotics may be used as first-line treatment for uncomplicated acute appendicitis, while surgery is often required for complicated cases 5, 6.
- Leukocytosis can be monitored as an indicator of the response to treatment, but it is not the only factor guiding management decisions 4.