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Laboratory values that have been associated with acute appendicitis include
leukocytosis, left shift, and elevated markers of inflammation such as C-
reactive protein (CRP) and erythrocyte sedimentation rate.
A "left shift" is a phrase used to note that there are a high number of young,
immature white blood cells present. Most commonly, this means that there is
an infection or inflammation present and the bone marrow is producing more
WBCs and releasing them into the blood before they are fully mature. This is
a natural immune response to infection and inflammation.
It is believed that cytokines (including IL-1 and TNF) accelerate the release
of cells from the postmitotic reserve pool in the bone marrow, leading to an
increased number of immature cells.
It is usually noted on microscopic examination of a blood smear. This
systemic effect of inflammation is most often seen in the course of an
active infection and during other severe illnesses such as hypoxia and shock.
Abstract
Neutrophil left shift and white blood cell (WBC) count are routine laboratory
tests used to assess neutrophil state, which depends on supply from the bone
marrow and consumption in the tissues. If WBC count is constant, the
presence of left shift indicates an increase of neutrophil consumption that is
equal to an increase of production. A decrease in WBC count indicates that
neutrophil consumption surpasses supply. During a bacterial infection, large
numbers of neutrophils are consumed. Thus, from onset of infection to
recovery, dynamic changes occur in WBC count and left shift data, reflecting
the mild to serious condition of the bacterial infection. Although various
stimuli in healthy and pathological conditions also cause left shift, a change
as sudden and significant is only seen in bacterial infection. Left shift does
not occur in the extremely early or late phases of infection; therefore,
assessing data from a single time point is unsuitable for diagnosing a
bacterial infection. We argue that time-series data of left shift and WBC
count reflect real-time neutrophil consumption during the course of a
bacterial infection, allowing more accurate evaluation of patient condition.
Copyright © 2016. Published by Elsevier B.V.
Highlights
A larger left shift indicates a larger neutrophil consumption in the blood.
A larger left shift represents a more severe bacterial infection.
Left shift reflects the severity of a bacterial infection consuming neutrophils
High WBC count in the blood shows sufficient neutrophil supply to the infected site.
WBC (or neutrophil) count in the blood depends on neutrophil supply and consumption.
A recent meta-analysis identified four studies that presented data for
perforated appendicitis. Based on these studies, high values of laboratory
markers of inflammation such as a WBC and granulocyte count and the CRP
level were relatively strong predictors of perforated appendicitis, whereas
low values were relatively strong predictors of not having perforated
appendicitis.