LEUCOCYTOSIS AFTER POST TRAUMATIC SPLENECTOMY- A PHYSIOLOGICAL EVENT OR INDICATOR OF SEPSIS.

Abstract

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. Aim and objectives: 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. 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: This Observational study (Prospective) was conducted in Madras Medical College and Rajiv Gandhi Government General Hospital, Chennai from June 2017 to October 2018. All patients undergoing splenectomy after trauma and other blunt trauma patients who underwent laparotomy were included in the study. Sample size is 30 cases of splenectomy. Parameters assessed were WBC count, platelet count, injury severity score, presence of post operative infections like pneumonia, abdominal abscess, septicaemia, urinary tract and wound infections. Results: The following are the results of the study.Injury severity score >21 is a signicant risk factor. Post operative day 5 WBC count 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 includes 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.