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. 2022 Apr;28(4):434-439.
doi: 10.14744/tjtes.2020.69027.

The role of hematological parameters in distinguishing acute appendicitis from lymphoid hyperplasia

Ahmet Kaya  1 , Kerem Karaman  2 , Mehmet Aziret  2 , Metin Ercan  2 , Elif Köse  3 , Yavuz Selim Kahraman  1 , Cengiz Karacaer  4
Affiliations

The role of hematological parameters in distinguishing acute appendicitis from lymphoid hyperplasia

Ahmet Kaya et al. Ulus Travma Acil Cerrahi Derg. 2022 Apr.

Abstract

Background: One of the most misdiagnosed appendicular pathologies is lymphoid hyperplasia (LH) that can be managed con-servatively when identified early and is self-limiting. The aim of this retrospective study was to compare acute appendicitis (AA) with LH in terms of hematological parameters to determine whether there is a hematological predictor to distinguish the two diseases.

Methods: Complete blood cell counts of patients with AA were compared with those having LH.

Results: One-hundred-ninety-five patients (118 male/77 female) underwent appendectomy. Histopathological examination re-vealed acute AA in 161 patients (82.6%), and negative appendectomy (NA) in 19 patients (9.7%). Of the NA specimens, 16 were LH (8.2%). Thirteen patients (6.7%) had AA with simultaneous LH. White blood cell count (p=0.030, neutrophil (p=0.009), neutrophil per-centage (p=0.009), and neutrophil/lymphocyte ratio (p=0.007) were significantly higher in AA whereas lymphocyte count (p=0.027), lymphocyte percentage (p=0.006) were significantly higher in LH. Multi logistic regression analysis revealed white blood cell count as the only independent predictor in distinguishing AA from LH with a 69.1% sensitivity, 80.0% specificity, 77.5% positive predictive value, and 72.1% negative predictive value. The cut-off value for white blood cell count was 11.3 Ku/L, and every one unit (1000/mm3) increase in white blood cell count raises the risk of AA by 1.24 times, while values below this value will increase the likelihood of LH.

Conclusion: The most predictive complete blood count parameter in distinguishing LH from AA appears to be as white blood cell count.

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Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Microscopic image of acute appendicitis and lymphoid hyperplasia (H&E staining ×4 HPF).
Figure 2
Figure 2
Receiver operating characteristics curves of WBC, NEU and NEU%.
See this image and copyright information in PMC

References

    1. Stewart B, Khanduri P, McCord C, Ohene-Yeboah M, Uranues S, Vega Rivera F, et al. Global disease burden of conditions requiring emergency surgery. Br J Surg. 2014;101:e9–22. - PubMed
    1. Seetahal SA, Bolorunduro OB, Sookdeo TC, Oyetunji TA, Greene WR, Frederick W, et al. Negative appendectomy: A 10-year review of a nationally representative sample. Am J Surg. 2011;201:433–7. - PubMed
    1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–64. - PubMed
    1. Tzanakis NE, Efstathiou SP, Danulidis K, Rallis GE, Tsioulos DI, Chatzivasiliou A, et al. A new approach to accurate diagnosis of acute appendicitis. World J Surg. 2005;29:1151–6. - PubMed
    1. Lintula H, Kokki H, Pulkkinen J, Kettunen R, Gröhn O, Eskelinen M. Diagnostic score in acute appendicitis. Validation of a diagnostic score (Lintula score) for adults with suspected appendicitis. Langenbecks Arch Surg. 2010;395:495–500. - PubMed