Ghazala Bhatti, Imran Munir, Warda Khurshid.
Can measurement of c-reactive protein (CRP) be used as a diagnostic adjunct to leukocyte count in the decision making of emergency appendisectomy?.
Pak J Surg Jan ;29(3):186-9.

Objective: To determine the role of CRP as an adjunct to leucocyte count in the diagnosis of acute appendicitis. Study Design: Descriptive Place and Duration of Study: Th e study was carried out at Abbassi Shaheed hospital, Surgical Unit III and Sir Syed College of Medical Sciences for Girls, Karachi from February 2010 to September 2010. Patients and Methods: Patients with clinical diagnosis of acute appendicitis on the basis of history and physical examination were included in the study. Laboratory tests were carried out on blood samples obtained from all patients of acute appendicitis on admission to the hospital. Th e upper normal limit of CRP and leukocyte count were defi ned as 6mg/l and 11000/ cmm respectively. Result: Aft er appendisectomy all the 60 appendix were hisotopathologically examined. eighteen (18) appendix were reactive lymphoid hyperplasia without mucosal and submucosal change. Twelve (12) appendices were of acute non suppurative appendix (Catarrhal group) and 30 appendices were acute suppurative appendix. four (04) out of eighteen (18) patients with reactive lymphoid hyperplasia (group II) had increase TLC where as 14 had TLC within normal range. Twelve (12) cases of acute non suppurative appendix ( group II) only two had raised TLC with normal CRP level. Out of 30 acute suppurative appendix, 12 patients had normal TLC while 18 had raised TLC, but CRP levels were found raised in all of them. Conclusion: Acute appendicitis seems unlikely in a patient with a normal leucocyte count and CRP value, even if clinical symptoms and signs indicate acute appendicitis.

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