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Year : 2020  |  Volume : 17  |  Issue : 1  |  Page : 30-35

Diagnostic feasibility of total leukocyte count, neutrophil percentage, and C-reactive protein in suspicious cases of acute appendicitis

1 Department of Surgery, College of Medicine, Basrah University, Basrah, Iraq
2 Department of Physiology, College of Pharmacy, Basrah University, Basrah, Iraq

Correspondence Address:
Dr. Ibrahim Falih Noori Alsubaiee
Department of Surgery, College of Medicine, Basrah University, Basrah
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/MJBL.MJBL_27_19

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Background: Acute appendicitis is quite common in general surgical practice. The classical history of central abdominal pain with anorexia migrating to the right lower abdomen is present in <50% of cases. The diagnosis of equivocal cases still represents clinical dilemma and diagnostic challenge. Objectives: The main purpose of this study was to evaluate the feasibility of triple blood tests for total leukocyte counts, percentage of neutrophils, and C-reactive protein (CRP) as inflammatory markers to diagnose cases with a suspicion of acute appendicitis. Methods: A total of 132 patients (78 males and 54 females) were diagnosed clinically by blood investigations as cases of acute appendicitis for whom appendectomy had been performed. Results: The results showed that the overall diagnostic accuracy rate was 91.7% after the final histopathological confirmation of acute appendicitis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy rate of CRP were high than those of total leukocyte count and neutrophil percentage; the difference, however, was not significant. The sensitivity, specificity, PPV, NPV, and accuracy rate of combined results of the three tests were significantly high than those of any test alone, which could be good adjuncts that help in the diagnosis of equivocal cases of acute appendicitis. More importantly, we found that when the results of the three tests were within the normal reference ranges, acute appendicitis is quite remote and very unlikely. Conclusion: It can be concluded from this study that the combined positive results of the three blood tests could be good predictors of acute appendicitis with high sensitivity, specificity, and accuracy rate. Moreover, when the results of these tests are normal, the likelihood of acute appendicitis reaches to zero.

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