From the Research
A white blood cell (WBC) count of 2.3 is significantly below the normal range and indicates leukopenia, which presents a serious concern for podiatry surgery, and I strongly recommend postponing the surgery until the WBC count improves to at least the lower end of the normal range. This low count indicates compromised immune function, creating a substantial risk of postoperative infection and impaired wound healing. The patient should be referred to a hematologist or primary care physician to investigate the cause of the leukopenia, which could result from medication side effects, viral infections, bone marrow disorders, or autoimmune conditions. Some studies have shown the importance of adequate white blood cell counts in preventing infections, such as the study by 1, which found that procalcitonin, a marker of sepsis, has reduced sensitivity and specificity in heavily leucopenic and immunosuppressed patients. If surgery is absolutely necessary due to emergency conditions like infection or trauma, enhanced infection control measures should be implemented, including prophylactic antibiotics, meticulous sterile technique, and close postoperative monitoring. The surgical team should also consider consulting with an infectious disease specialist before proceeding. The use of granulocyte colony-stimulating factors (G-CSF) such as filgrastim or pegfilgrastim may be considered to stimulate the production of white blood cells, as shown in studies such as 2, which found that pegfilgrastim induces anti-PEG IgM in a dose-dependent manner. However, the primary concern should be to address the underlying cause of the leukopenia and to ensure that the patient's immune system is adequately functioning before proceeding with surgery. In terms of the efficacy and safety of G-CSF biosimilars, studies such as 3 and 4 have shown that they are comparable to reference G-CSF, but the incidence of neutropenia and febrile neutropenia may be higher. Ultimately, the decision to proceed with surgery should be made on a case-by-case basis, taking into account the patient's overall health status, the severity of the leukopenia, and the potential risks and benefits of the procedure. The immune system relies on adequate white blood cells to fight infection, and proceeding with surgery when these cells are severely depleted could lead to serious complications that might outweigh the benefits of the podiatric procedure.