Ulus Travma Acil Cerrahi Derg. 2022; 28(4): 434-439 | DOI: 10.14744/tjtes.2020.69027

Akut apandisiti lenfoid hiperplaziden ayýrmada hematolojik parametrelerin rolü

Ahmet Kaya¹, Kerem Karaman², Mehmet Aziret², Metin Ercan², Elif Köse³, Yavuz Selim Kahraman¹, Cengiz Karacaer^4
1Sakarya Üniversitesi Týp Fakültesi, Cerrahi Onkoloji Bilim Dalý, Sakarya
²Sakarya Üniversitesi Týp Fakültesi, Gastroenteroloji Cerrahisi Bilim Dalý, Sakarya
³Sakarya Üniversitesi Týp Fakültesi, Halk Saðlýðý Anabilim Dalý, Sakarya
⁴Sakarya Üniversitesi Týp Fakültesi, Ýç Hastalýklarý Anabilim Dalý, Sakarya

AMAÇ: Sýk karýþan apendiküler patolojilerden biri, erken teþhis edildiðinde konservatif olarak tedavi edilebilen ve kendi kendini sýnýrlayabilen lenfoid hiperplazidir. Bu geriye dönük çalýþmanýn amacý akut apandisiti lenfoid hiperplaziyle hematolojik parametreler açýsýndan karþýlaþtýrmak ve iki hastalýðý ayýrt etmede hematolojik bir prediktör olup olmadýðýný saptamaktýr.
GEREÇ VE YÖNTEM: Akut apandisit tanýlý hastalar ile lenfoid hiperplazi tanýlý hastalarýn tam kan sayýmlarý kýyaslandý.
BULGULAR: Yüz doksan beþ hastaya (118 erkek/77 kadýn) apendektomi yapýldý. Histopatolojik incelemede 161 hastada (%82.6) akut apandisit, 19 hastada (%9.7) negatif apendektomi saptandý. Negatif apendektomilerin 16’sý lenfoid hiperplaziydi (%8.2). On üç hastada (%6.7) eþ zamanlý lenfoid hiperplazi ile birlikte akut apandisit saptandý. Beyaz küre sayýsý (p=0.030, nötrofil sayýsý (p=0.009), nötrofil yüzdesi (p=0.009) ve nötrofil/lenfosit oraný (p=0.007) akut apandisitte anlamlý olarak daha yüksek iken lenfosit sayýsý (p=0.027), lenfosit yüzdesi (p=0.006) lenfoid hiperplazide anlamlý olarak daha yüksekti. Çoklu lojistik regresyon analizinde, akut apandisiti lenfoid hiperplaziden ayýrmada beyaz küre sayýsý %69.1 duyarlýlýk; %80 özgüllük; %77.5 pozitif prediktif deðer ve %72.1 negatif prediktif deðer ile tek baðýmsýz prediktör olarak saptandý. Kesit deðeri 11.3 Ku/L olan beyaz küre sayýsýnýn her 1 birim (1000/mm3) artýþý, akut apandisit riskini 1.24 kat arttýrýrken, bunun altýndaki deðerlerde lenfoid hiperplazi olma olasýlýðý artmaktadýr.
TARTIÞMA: Lenfoid hiperplaziyi akut apandisitten ayýrmada en güçlü hematolojik parametre beyaz küre olarak gözükmektedir.

Anahtar Kelimeler: Akut apandisit, beyaz küre sayýsý, lenfoid hiperplazi; lenfosit; nötrofil; tam kan sayýmý.

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

Ahmet Kaya¹, Kerem Karaman², Mehmet Aziret², Metin Ercan², Elif Köse³, Yavuz Selim Kahraman¹, Cengiz Karacaer^4
1Department, of Surgical Oncology, Sakarya University Faculty of Medicine, Sakarya-Turkey
²Department of Gastroenterological Surgery, Sakarya University Faculty of Medicine, Sakarya-Turkey
³Department of Public Health, Sakarya University Faculty of Medicine, Sakarya-Turkey
⁴Department of Internal Medicine, Sakarya University Faculty of Medicine, Sakarya-Turkey

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.

Keywords: Acute appendicitis, complete blood count, lymphocyte; lymphoid hyperplasia; neutrophil; white blood cell count.

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