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White cell count and diagnosing appendicitis in pregnancy
  1. Rob Williams,
  2. Kevin Mackway-Jones
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL

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    Report by Rob Williams, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant

    Clinical scenario

    A 27 year old woman who is 14 weeks pregnant, presents to the emergency department with the symptoms and signs of appendicitis. You refer the case to the acute surgical team who ask you to obtain a white cell count. You wonder whether this test has any value in this situation.

    Three part question

    In [pregnant women with a clinical diagnosis of appendicitis] is [a raised white cell count] useful in [diagnosis]?

    Search strategy

    Medline 1966–06/00 using the OVID interface. ({exp appendicitis OR} AND {exp leukocyte count OR leukocyte count$.mp OR neutrophil count$.mp OR white cell count$.mp} AND {exp pregnancy OR}) LIMIT to human AND english.

    Search outcome

    Altogether seven papers found of which five were irrelevant or of insufficient quality for inclusion. The remaining two papers are shown in table 2.

    Table 2


    The only available studies deal with the wrong spectrum of patients. The women included all underwent appendicectomy; this is a selected sample of pregnant women presenting to emergency departments with the clinical signs and symptoms of appendicitis.

    Clinical bottom line

    There is no evidence to support the use of isolated white cell counts in the diagnosis of acute appendicitis in pregnant women.

    Report by Rob Williams, Clinical Fellow Search checked by Kevin Mackway-Jones, Consultant


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