Determining “True” Leukocytosis in Bloody Joint Aspiration

Ghanem, Elie; Houssock, Carrie; Pulido, Luis; Han, Seung-Beom; Jaberi, Fereidoon Mojtahed; Parvızı, Javad

doi:10.1016/j.arth.2007.08.016

Cited by 45 publications

(22 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These included: serum WBC and red blood cell (RBC) counts, ESR and CRP, synovial WBC and RBC counts, and the corrected synovial fluid WBC count as described by Ghanem et al [12] was calculated (corrected WBC count = WBC synovial fluid -[WBC count blood 9 RBC synovial fluid/RBC blood]). Hereafter, all WBC counts will refer to the corrected WBC count.…”

Section: Variables Outcome Measures Data Sources and Biasmentioning

confidence: 99%

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

Newman

George

Klika

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

Background Periprosthetic joint infection is a serious complication after THA and commonly is treated with a two-stage revision. Antibiotic-eluting cement spacers are placed for local delivery of antibiotics. Aspirations may be performed before the second-stage reimplantation for identification of persistent infection. However, limited data exist regarding the diagnostic parameters of synovial fluid aspiration with or without saline lavage from a hip with an antibiotic-loaded cement spacer. Questions/purposes We asked: (1) For hips with antibiotic cement spacers, does saline lavage influence the diagnostic validity of aspirations? (2) What is the diagnostic accuracy of preoperative aspirations performed on hips with antibiotic cement spacers using the Musculoskeletal Infection Society (MSIS) criteria, stratified by saline and nonlavage? (3) For hips with antibiotic spacers, what are the optimal thresholds for synovial fluid white blood cell (WBC) count and polymorphonuclear neutrophil (PMN) percentage for diagnosing infections? Methods One hundred seventy-four hips (155 patients) with antibiotic-eluting cement spacers inserted between October 2012 and July 2015 were reviewed. Of these, 98 hips (80 patients) met the inclusion criteria and were included in the analysis (77 nonlavage, 21 saline lavage aspirations). Laboratory data from the aspiration and preoperative workup and intraoperative details were collected. Infection status of each hip procedure was determined One of the authors certifies that he (WKB), or a member of his immediate family, has or may receive payments or benefits, during the study period an amount of USD 100,001 to USD 1,000,000 from Stryker (Kalamazoo, MI, USA); an amount of USD 100,001 to USD 1,000,000 from Exactech (Gainesville, FL, USA); an amount of less than USD 10,000 from Zimmer (Warsaw, IN, USA); an amount of less than USD 10,000 from Custom Orthopaedic Solutions (Cleveland, OH, USA; an amount of USD 100,001 to USD 1,000,000 from KEF Healthcare (Westminster, CO, USA); amount of less than USD 10,000 from iVHR (Cleveland, OH, USA); an amount of less than USD 10,000 from PeerWell (San Francisco, CA, USA), and has received research support from Zimmer (Warsaw, IN, USA), DJO (Vista, CA, USA), and Orthosensor (Dania Beach, FL, USA). One of the authors (CAH) or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 from KCI (San Antonio, TX, USA); an amount of less than USD 10,000 from Zimmer Biomet (Warsaw, IN, USA); an amount of less than USD 10,000 from Covance (Princeton, NJ, USA); an amount of less than USD 10,000 from Pfizer (New York, NY, USA); and has received research support funding from Stryker (Kalamazoo, MI, USA), Myoscience (Fresno, CA, USA), CD Diagnostics (Claymont, DE, USA), KCI (San Antonio, TX, USA), OREF (Rosemont, IL, USA), and Pacira (Parsippany, NJ, USA). All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research1 editors and board members are ...

show abstract

Section: Variables Outcome Measures Data Sources and Biasmentioning

confidence: 99%

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

Newman

George

Klika

et al. 2017

Clinical Orthopaedics &Amp; Related Research

View full text Add to dashboard Cite

show abstract

“…The formula described by Ghanem et al [6] applied to the joint fluid analysis in an attempt to account for the WBCs in a ''bloody tap'' does not appear to offer superior diagnostic performance over the absolute number of WBCs observed in this case (Table 3). While the reason for this finding is unclear, it may be in part due to the large difference in average WBC counts between the infected and noninfected groups.…”

Section: Discussionmentioning

confidence: 99%

“…In an attempt to correct for postoperative hemarthrosis that would be expected after primary TKA, an ''adjusted WBC count'' was calculated for those with peripheral blood draws [6]. The formula utilized attempted to predict the expected WBC count in the synovial fluid due to hemarthrosis based on the synovial red blood cell (RBC) count and the ratio of WBC count to RBC count in the peripheral blood.…”

Section: Methodsmentioning

confidence: 99%

The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis

Bedair

Ting

Jacovides

et al. 2011

Clinical Orthopaedics &Amp; Related Research

Self Cite

234

128

View full text Add to dashboard Cite

Background Synovial fluid white blood cell count is useful for diagnosing periprosthetic infections but the utility of this test in the early postoperative period remains unknown as hemarthrosis and postoperative inflammation may render standard cutoff values inaccurate. Questions/purposes We evaluated the diagnostic performance of four common laboratory tests, the synovial white blood cell count, differential, C-reactive protein, and erythrocyte sedimentation rate to detect infection in the first 6 weeks after primary TKA. Methods We reviewed 11,964 primary TKAs and identified 146 that had a knee aspiration within 6 weeks of surgery. Infection was diagnosed in 19 of the 146 knees by positive cultures or gross purulence. We compared demographic information, time from surgery, and the laboratory test values between infected and noninfected knees to determine if any could identify infection early postoperatively. Receiver operating characteristic curves were constructed to determine optimal cutoff values for each of the test parameters. Results Synovial white blood cell count (92,600 versus 4200 cells/lL), percentage of polymorphonuclear cells (89.6% versus 76.9%), and C-reactive protein (171 versus 88 mg/L) were higher in the infected group. The optimal synovial white blood cell cutoff was 27,800 cells/lL (sensitivity, 84%; specificity, 99%; positive predictive value, 94%; negative predictive value, 98%) for diagnosing infection. The optimal cutoff for the differential was 89% polymorphonuclear cells and for C-reactive protein 95 mg/L. Conclusions With a cutoff of 27,800 cells/lL, synovial white blood cell count predicted infection within 6 weeks after primary TKA with a positive predicted value of 94% and a negative predictive value of 98%. The use of standard cutoff values for this parameter (* 3000 cells/lL) would have led to unnecessary reoperations.

show abstract

“…White blood cell (WBC), glucose and protein levels in the CSF were analyzed for each sample (all cases showed WBC counts higher than 5 cells/mm 3 ). We excluded those samples with elevated WBC counts attributable to contamination with blood after a corrective formula was applied [18]. Group 2 comprised 52 children (40 males, 12 females, mean age 8 months; SD 12 months; median age 5.4 months, age range: 1 month–6 years, Table 1) with confirmed viral (n = 15) or bacterial (n = 37) peripheral infections without CNS involvement.…”

Section: Methodsmentioning

confidence: 99%

Cerebrospinal Fluid Neopterin Analysis in Neuropediatric Patients: Establishment of a New Cut Off-Value for the Identification of Inflammatory-Immune Mediated Processes

et al. 2013

View full text Add to dashboard Cite

ObjectiveA high level of cerebrospinal fluid (CSF) neopterin is a marker of central nervous system inflammatory-immune mediated processes. We aimed to assess data from 606 neuropediatric patients, describing the clinical and biochemical features of those neurological disorders presenting CSF neopterin values above a new cut-off value that was defined in our laboratory.MethodsTo establish the new CSF neopterin cut-off value, we studied two groups of patients: Group 1 comprised 68 patients with meningoencephalitis, and Group 2 comprised 52 children with a confirmed peripheral infection and no central nervous system involvement. We studied 606 CSF samples from neuropediatric patients who were classified into 3 groups: genetic diagnosis (A), acquired/unknown etiologic neurologic diseases (B) and inflammatory-immune mediated processes (C).ResultsThe CSF neopterin cut-off value was 61 nmol/L. Out of 606 cases, 56 presented a CSF neopterin level above this value. Group C had significantly higher CSF neopterin, protein and leukocyte values than the other groups. Sixteen of twenty-three patients in this group had a CSF neopterin level above the cut-off, whereas three and seven patients presented increased leukocyte and protein values, respectively. A significant association was found among CSF neopterin, proteins and leukocytes in the 606 patients. White matter disturbances were associated with high CSF neopterin concentrations.ConclusionsAlthough children with inflammatory-immune mediated processes presented higher CSF neopterin values, patients with other neurological disorders also showed increased CSF neopterin concentrations. These results stress the importance of CSF neopterin analysis for the identification of inflammatory-immune mediated processes.

show abstract

Determining “True” Leukocytosis in Bloody Joint Aspiration

Cited by 45 publications

References 18 publications

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers?

The Mark Coventry Award: Diagnosis of Early Postoperative TKA Infection Using Synovial Fluid Analysis

Cerebrospinal Fluid Neopterin Analysis in Neuropediatric Patients: Establishment of a New Cut Off-Value for the Identification of Inflammatory-Immune Mediated Processes

Contact Info

Product

Resources

About