Leucocytosis after Post Traumatic Splenectomy: A Physiological Event or Indicator of Sepsis

Swetha, V (2019) Leucocytosis after Post Traumatic Splenectomy: A Physiological Event or Indicator of Sepsis. Masters thesis, Madras Medical College, Chennai.


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BACKGROUND: Blunt injury abdomen causes a variety of injuries, the commonest being solid organ injury. Among the solid organs, the spleen is most commonly injured. Operative management plays a major role in treatment of blunt injury abdomen. Various postoperative complications can occur following emergency laparotomy including surgical site infection, abdominal abscess, urinary tract infection and lower respiratory tract infection. Diagnosing these infections becomes particularly challenging following splenectomy because of the unusual physiological response to leucocyte count and platelet count. The aim of this study is to assess the three risk factors i.e Total Leucocyte Count, Platelet count/Total Leucocyte Count Ratio and Injury Severity Score in patients undergoing splenectomy and to compare them with other patients undergoing laparotomies other than splenectomy for blunt injury abdomen in order to achieve a cut off value beyond which persistence of leucocytosis may denote infection. AIMS AND OBJECTIVES: 1. To study the WBC Count and Platelet Count (PC)/WBC Count ratio in infected and non infected individuals who have undergone post traumatic splenectomy compared to other blunt abdomen trauma patients who have undergone laparotomy. 2. To study the relationship of three prognostic factors : WBC count, PC/WBC count ratio and Injury Severity Score in individuals who have undergone emergency laparotomy after trauma and their role in post operative infection. MATERIALS AND METHODS: Study Centre: Institute of General Surgery, MMC and RGGGH, Chennai. Sample Size: 30cases of splenectomy/ 30 cases of blunt injury abdomen who underwent other laparotomies. Duration of Study: June 2017 to October 2018. Study Design: Prospective Observational Comparative Study. Inclusion Criteria: 1. All patients undergoing splenectomy after trauma. 2. Other blunt trauma patients who underwent laparotomy. Exclusion criteria: Patients undergoing splenectomy for reasons other than trauma. Assessment of parameters: WBC count, Platelet count, Injury Severity Score, Presence of postoperative infections such as pneumonia, abdominal abscess septicaemia, urinary tract and wound infections. RESULTS: The following are the results of the study: • Injury severity score >21 is a significant risk factor. • Post operative day 5 TC more than 15000 indicates infection. • PC/TC ratio < 20 on the 5th post operative day indicates infection. • Patients who underwent laparotomies other than splenectomy showed elevated Total count and Decreased platelet/total count ratio only if infected. • Presence of more than 1 risk factor is associated with 72% chance of infection. CONCLUSION: Post operative day 5 is the earliest time that infected and non infected patients can be distinguished on the basis of total count and PC/TC ratio. Risk factors for infection: Total count >15,000 on 5th post operative day, PC/TC ratio < 20 on 5th post operative day, ISS > 21. • Presence of more than one risk factor carries 72% increased chance of infection and these patients should be monitored with high degree of suspicion. • Presence of increased total count and decreased platelet/total count on any post operative day in a patient who has undergone laparotomy other than splenectomy should be considered an indicator of infection and should be treated promptly.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Blunt abdomen trauma, splenectomy, laparotomy, leucocytosis, thombocytosis, platelet/total count ratio, infection.
Subjects: MEDICAL > General Surgery
Depositing User: Subramani R
Date Deposited: 04 Sep 2019 12:28
Last Modified: 06 Sep 2019 02:48
URI: http://repository-tnmgrmu.ac.in/id/eprint/11457

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