Normal Reference Interval of WBC Count After On - Pump Coronary Artery Bypass Graft; When Values Could Be Misleading

Abstract

BackgroundApplying the cardiopulmonary pump produces inflammatory responses and induces leukocytosis. White Blood Cell (WBC) count has a diagnostic value for detecting different infections. In this study, we want to redefine the normal value reference intervals of WBC count in Coronary Artery Bypass Graft (CABG) patients, to prevent misdiagnose leukocytosis as a sign of infection.MethodsIn an observational study, 140 patients who underwent on - pump CABG were enrolled to find out normal values of the reference interval. WBC counts were evaluated for all of them one day before the operation, first 30 minutes of ICU entrance, after 24 hours, and 48 hours after operation. Normal values of reference intervals were calculated for each measurement by two different statistical methods.ResultsThere were 102 men and 38 women with age average of 61 years. There was no significant difference between genders’ WBC counts before operation (P = 0.151), ICU entrance (P = 0.391), 24 hours after surgery (P = 0.698), and 48 hours after surgery (P = 0.523). The mean values of WBC after surgery were higher than the normal range of reference interval and had an increasing trend in the first 48 hours after surgery. The WBC values were significantly different between pre and post operation (before operation and ICU admission (P = 0.001), ICU admission and 24 hours later (P = 0.001), 24 hours after surgery, and 48 hours after surgery (P = 0.001)). All post - operative reference values were significantly higher than the range for the general population.ConclusionsThere is a significant increase in WBC count after on - pump CABG. The normal range of WBC should be revised and adjusted to prevent misinterpretation as a sign of infection.

The impact of del Nido cardioplegia solution on blood morphology parameters

“…It increases in the first 24 hours and decreases after 48 hours. 16 Postoperation WBC reference intervals are higher than the WBC normal ranges. 16 A pretreatment with lidocaine mitigated endotoxininduced increases in polymorphonuclear granulocytes (PMN) adherence, PMN activation, migration to the inflammatory site, and metabolic function, assessed by an inhibition of free radical production.…”

“…16 Postoperation WBC reference intervals are higher than the WBC normal ranges. 16 A pretreatment with lidocaine mitigated endotoxininduced increases in polymorphonuclear granulocytes (PMN) adherence, PMN activation, migration to the inflammatory site, and metabolic function, assessed by an inhibition of free radical production. 17 Nishina et al 18 reported that pre-or early posttreatment with lidocaine attenuates the late phase of acid installation-induced lung injury in rabbits.…”

“…It increases in the first 24 hours and decreases after 48 hours. 16 Post-operation WBC reference intervals are higher than the WBC normal ranges. 16…”

“Normal” TEWL‐how can it be defined? A systematic review

“…For years, glomerular filtration rate calculations have included race as a variable of consideration, but this practice has recently been re‐examined to determine its utility 65 . In addition, normal white blood cell count reference intervals are continuously being discussed in the context of patient variables, with one example showing an increased reference range following coronary artery bypass 67 . These two examples show how the definition of normality in biologic measurements is fluid and continuously changing as new information on variables affecting them develops, and this is certainly no different with TEWL as shown in this review.…”