Postsplenectomy leukocystosis: physiologic or an indicator of infection?

The records of 42 patients who underwent splenectomy following blunt abdominal trauma were reviewed to determine whether white blood cell (WBC) count is a useful indicator of acute infection in the postoperative period. Patients, ranging in age from 14 to 54 years, were divided into two groups: 1) infected (n = 18) and 2) noninfected (n = 24). Group average daily WBC counts (thousands/mm3) and differential counts (polymorphonuclear leukocyte/bands) were evaluated for the first 14 postoperative days. The infected group had a mean WBC of 21.2 and a mean differential count of 73/8. The average daily WBC count began to rise on Day 4 (WBC = 10.8) and peaked on Day 7 at 27.8. There were 30 episodes of infection: 14 pneumonias and 16 others, including sinusitis, empyema, subphrenic abscess, urinary tract infection, and bacteremias. The noninfected group had a mean WBC count of 14.2 and a mean differential of 73/5. For this group, the average WBC peaked by the postoperative Day 2 (WBC = 15.9), then the trend was downward. Thus, for patients with traumatic splenic injuries, WBC count may predict infection in the postsplenectomy period. In the noninfected group, the authors observed no average daily WBC count above 16; whereas, in the infected group, no average daily WBC count less than 16 was observed. The differential counts were not significantly different between the two groups.