A 14-year-old boy is admitted to the emergency department with severe abdominal pain and a tentative diagnosis of appendicitis. His white blood cell count shows an elevated number of white blood cells with an increased percentage of “band cells.”
A. Explain the significance of this finding
The Correct Answer and Explanation is :
Answer: The elevated white blood cell (WBC) count with an increased percentage of “band cells” indicates an acute inflammatory response, likely due to a bacterial infection. This finding supports the diagnosis of appendicitis, particularly if it is in an advanced or severe stage such as acute suppurative or perforated appendicitis.
Explanation:
The term “band cells” refers to immature neutrophils released by the bone marrow in response to an acute infection or significant inflammatory process. Normally, neutrophils constitute the majority of the white blood cells in circulation, and most are segmented or mature. However, when the body faces an acute bacterial infection or severe inflammation, the bone marrow rapidly releases neutrophils, including their immature forms (band cells), to meet the increased demand for immune response. This phenomenon is termed a “left shift.”
In the context of suspected appendicitis, the presence of an elevated WBC count with a significant percentage of band cells indicates that the body is actively fighting an infection, most likely caused by bacterial overgrowth in the inflamed appendix. Appendicitis typically progresses through stages, starting with localized inflammation (early appendicitis) and potentially advancing to suppurative (pus-forming), gangrenous, or even perforated appendicitis if untreated. In the latter stages, the immune response intensifies, leading to a pronounced left shift.
This finding helps guide clinical decision-making. Along with symptoms like abdominal pain (often localized to the right lower quadrant), nausea, fever, and laboratory results, it strongly supports the diagnosis of appendicitis. Prompt surgical intervention, typically via appendectomy, is essential to prevent complications like peritonitis or abscess formation.
In summary, the elevated WBC count and left shift in this case reflect an acute bacterial infection and are crucial diagnostic markers that align with the clinical suspicion of appendicitis, guiding timely and appropriate management.