Nama : Heni Apriani

Nim : 1602109

Prodi :DIII Keperawatan IIC

White blood cell count is a poor predictor of severity of disease in the

diagnosis of appendicitis

The American Surgeon; Atlanta Vol. 64, Iss. 10, (Oct 1998): 983-5.

Abstract

The white blood cell (WBC) count is considered to be a useful test in the diagnosis of
appendicitis. The purpose of this study was to examine the clinical features of patients with
normal WBC appendicitis and also to determine whether a higher WBC count correlates
with a more advanced stage of appendicitis. Patients with pathologically confirmed
appendicitis from January 1989 to December 1994 were included in the study (n = 1919).
The age, gender, temperature, length of hospital stay, and severity of disease (1 = acute
appendicitis; 2 = gangrenous appendicitis; 3 = perforated appendicitis with abscess
formation; 4 = appendicitis with diffuse peritonitis) were compared for patients with a
normal WBC count (range, 3.8-10.9) versus those who had an elevated WBC count. A
normal WBC count was seen in 11 per cent of patients (n = 209). There was no difference
in age, temperature, gender, or severity of disease in the patients with a normal WBC count
compared with those with an elevated WBC count (P > 0.05). The severity of disease of
patients with a normal WBC count were: 1 = 58 per cent; 2 = 13 per cent; 3 = 7 per cent;
and 4 = 22 per cent. For patients with an elevated WBC count the scores were: 1 = 57 per
cent; 2 = 17 per cent; 3 = 13 per cent; and 4 = 14 per cent. The proportion of gangrenous
and perforated appendicitis in the patients with a normal WBC count is the same as in the
patients with an elevated WBC count.

Headnote

The white blood cell (WBC) count is considered to be a useful test in the diagnosis of
appendicitis. The purpose of this study was to examine the clinical features of patients with
normal WBC appendicitis and also to determine whether a higher WBC count correlates
with a more advanced stage of appendicitis. Patients with pathologically confirmed
appendicitis from January 1989 to December 1994 were included in the study (n = 1919).
The age, gender, temperature, length of hospital stay, and severity of disease (1 = acute
appendicitis; 2 = gangrenous appendicitis; 3 = perforated appendicitis with abscess
formation; 4 = appendicitis with diffuse peritonitis) were compared for patients with a
normal WBC count (range, 3.8-10.9) versus those who had an elevated WBC count. A
normal WBC count was seen in 11 per cent of patients (n = 209). There was no difference
in age, temperature, gender, or severity of disease in the patients with a normal WBC count
compared with those with an elevated WBC count (P > 0.05). The severity of disease of
patients with a normal WBC count were: 1 = 58 per cent; 2 = 13 per cent; 3 = 7 per cent;
and 4 = 22 per cent. For patients with an elevated WBC count the scores were: 1 = 57 per
cent; 2 =17 per cent; 2 =17 per cent; 3 = 13 per cent; and 4 = 14 per cent. The proportion of
gangrenous and perforated appendicitis in the patients with a normal WBC count is the
same as in the patients with an elevated WBC count.

APPENDICITIS IS AN important public health problem; it affects all age groups, with an
overall incidence of 11 cases/ 10,000 population/year.1 The white blood cell (WBC) count
is elevated in 70 to 90 per cent of patients with acute appendicitis and is thought to be more
specific in advanced disease, such as gangrenous or perforated appendicitis with the
associated generalized inflammatory response.2-4 This inflammatory response is
characterized by a neutrophilia and lymphopenia.5-7 In this study, we examined whether
the WBC count is a predictor of the severity of appendicitis. In addition, a comparison was
made of the clinical course and severity of disease for patients with pathologically
confirmed appendicitis with normal and elevated WBC counts.

Results

The demographic data of the patients in the normal and elevated WBC count groups are
listed in Table 1. The age, race, gender, temperature, and hematocrit were not different
between the two groups. In addition, the proportion of patients with advanced appendicitis
was the same in both groups. Examination of the clinical features of patients with a normal
WBC count revealed that a typical history and physical exam for appendicitis was common.
Virtually all presented with right lower quadrant pain (98%) and had anorexia, nausea, or
vomiting (91%). Diarrhea was noted in 24 per cent of patients. The average duration of
symptoms was 2.3 +/- 1.7 days. A differential analysis was performed on 144 of the 185
normal WBC counts, and this showed that neutrophilia was present in 47 per cent and
lymphopenia in 37 per cent of these patients. The differential analysis was normal in over
half of the patients who had a normal total WBC count. As expected, the length of hospital
stay was dependent on the severity of disease.
 Abbrevation

1. White Blood Cell (WBC) : Sel darah putih

2. Nausea, Vomiting, and Diarrhea (NVD : mual, muntah, dan diare
3. Clinical (Cl) : Klinis
4. Lymphopenia (LYP) :Berkurangnya jumlah eritrosit di
dalam darah, jumlahnya sama dengan 5000/mm atau kurang
5. Temperature (Temp.) : Suhu
6. Inflammatory (INF) : Inflamasi, Inflamasi atau peradangan
adalah upaya tubuh untuk perlindungan diri, tujuannya adalah untuk menghilangkan
rangsangan berbahaya, termasuk sel-sel yang rusak, iritasi, atau patogen dan
memulai proses penyembuhan
7. Symptoms (SYM) : Gejala
8. Appendicitis (AP) : Radang usus buntu
9. Physical (PHS) : Fisik
10. Disease (dz) : Penyakit
11. Pathological (Path) : Patologi
12. Patients (Pat) : Pasien
13. Demographic (Demogr) : demografis
14. Severity (SEV) : Keparahan
15. Hematocrit (HTC) : Hematokrit