Significance of hemogram on diagnosis of acute appendicitis during pregnancy

BACKGROUND: Acute appendicitis (AA) is the most common emergency surgical condition during pregnancy after obstetric and gynecological pathologies. Urgent and accurate diagnosis of AA in pregnant patients reduces maternal and fetal morbidity/mortality rates. This study evaluated the significance of hemogram to diagnose AA during pregnancy.
METHODS: Forty-seven pregnant patients operated for AA in the Ordu or Ondokuz Mayis University Medical School Hospitals between January 2007 and December 2017 were compared with 47 healthy pregnant women in terms of hemogram parameters, including the white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) values. The operated group was evaluated based on post-operative pathologic results and subclassified into appendicitis positive (Group A) and appendicitis negative (Group B) groups. The subgroups were compared to the control group.
RESULTS: The WBC and neutrophil count and mean NLR and PLR values were significantly higher in Group A compared to Group B and the control group (p<0.001). The mean lymphocyte count was significantly lower in Group A compared to other groups (p<0.001). The MPV and RDW values and mean platelet count showed no significant difference between groups (p>0.05). When cutoff values for WBC, neutrophil count, NLR, PLR, and lymphocyte counts were set to >10300, >7950, >5.50, >155.2, and ≤1330, respectively, the sensitivity rates were 72.5%, 80%, 90%, 77.5% and 85%, whereas specificity rates were 72.3%, 79.7%, 89.4%, 74.5%, and 82.5%, respectively.
CONCLUSION: When comparing pregnant women diagnosed with AA to patients operated for suspected AA and healthy pregnant women, the WBC and neutrophil count and NLR and PLR values were found to be significantly higher, whereas lymphocyte counts were lower. In addition to medical history, physical examination and imaging techniques, hemogram parameters should be considered to diagnose AA in pregnant women.

Gebelikte hemogramýn akut apandisit tanýsýndaki önemi

AMAÇ: Akut apandisit (AA) gebelik döneminde obstetrik ve jinekolojik patolojilerden sonra en sýk acil cerrahi gerektiren durumdur. Gebe hastalarda AA tanýsýnýn hýzlý ve doðru konulmasý maternal ve fetal morbite/mortalite oranlarýný azaltýr. Bu çalýþma, hemogramýn gebelik döneminde AA tanýsý koymadaki önemini irdelemektedir.
GEREÇ VE YÖNTEM: Ordu veya Ondokuz Mayýs Üniversitesi Týp Fakültesi Hastanesi’nde Ocak 2007–Aralýk 2017 yýllarý arasýnda AA nedeniyle ameliyat edilen 47 gebe hasta ile 47 saðlýklý gebe hastanýn hemogram parametrelerinden beyaz kan hücresi (WBC) sayýsý, nötrofil sayýsý, lenfosit sayýsý, platelet sayýsý, nötrofil/lenfosit oraný (NLO), platelet/lenfosit oraný (PLO), mean platelet volüm (MPV) ve kýrmýzý hücre daðýtým geniþliði (RDW) deðerleri kýyaslandý. Ameliyat edilen hastalar, patoloji sonucu apandisit olanlar Grup A normal olanlar ise Grup B olarak ikiye ayrýldý ve kontrol grubu ile kýyaslandý.
BULGULAR: Grup A hastalarýnýn WBC sayýsý, nötrofil sayýsý, ortalama NLO ve PLO deðerleri Grup B ve kontrol hastalarýndan anlamlý olarak yüksek tespit edildi (p<0.001). Lenfosit sayýsý ortalamasýnýn Grup A hastalarýnda diðer gruplardan anlamlý olarak düþük olduðu görüldü (p<0.001). MPV, RDW ve ortalama platelet sayýsý açýsýndan gruplar arasýnda anlamlý bir farklýlýk yoktu (p>0.05). WBC sayýsý, nötrofil sayýsý, NLO, PLO ve lenfosit sayýsý için kestirim deðerleri sýrasýyla >10300, >7950, >5.50, >155.2 ve ≤1330 olarak alýndýðýnda sensivite oranlarý sýrasýyla %72.5, %80, %90, %77.5 ve %85 olarak gözlenirken spesifite oranlarý ise sýrasýyla %72.3, %79.7, %89.4, %74.5 ve %82.5 olarak tespit edildi.
TARTIÞMA: Akut apandisit tanýsý olan gebe kadýnlarda WBC sayýsý, nötrofil sayýsý, NLO ve PLO deðerleri kontrol grubu ve apandisit þüphesi nedeniyle ameliyat edilen hastalardan istatistiksel olarak anlamlý olacak þekilde yüksek bulunurken lenfosit sayýsý ise düþük bulunmuþtur. Gebe kadýnlarda AA tanýsý koymak için anamnez, fizik muayene ve görüntüleme yöntemleri ile birlikte hemogram parametreleride göz önünde bulundurulmalýdýr.