Leukemoid Reaction in a Case of Chronic Cholecystitis With Focal Mild Acute Inflammation

Leukemoid reaction is a rare condition of marked increase of the white blood cells (WBC) in the peripheral blood, mostly more than 50 × 109/L. Although its most common cause is infection, acute or chronic cholecystitis has been hardly mentioned. This report aimed to present the leukemoid reaction found in a Thai who had chronic cholecystitis with focal acute inflammation. A 74-year-old woman had low-graded fever and generalized vague abdominal discomfort for 2 days. The physical examination showed the body temperature 37.7 °C and unremarkable abdominal signs. Her blood tests showed: hemoglobin 9.0 g/L, WBC 52.48 × 109/L, neutrophil 91%, band form 1%, platelet 434 × 109/L, and alkaline phosphatase (ALP) 290 U/L. The blood cultures yielded no growth. The computed tomography of the abdomen revealed 2 stones in the common bile duct (CBD) causing obstruction; the gall bladder (GB) showed mild dilatation with thin wall containing multiple small gall stones; no pericholecystic fluid and normal size of spleen. She promptly underwent operative cholecystectomy, CBD choledochoscopy, stones removal and T-tube choledochostomy. Along with the surgery, intravenous ertapenem was also administered. The pathology of the gall bladder was chronic cholecystitis with focal mild acute inflammation. With these therapies, fever daily decreased and finally disappeared within 5 days meanwhile the WBC count also gradually diminished every day till 8.04 × 109/L within 7 days. The WBC count was still normal one month later. The diagnosis of leukemoid reaction was concluded and it was presumably be associated with chronic calculous cholecystitis with focal acute inflammation although the BCR-ABL translocation had never been explored.

A study to evaluate the diagnostic value investigations in early diagnosis of septicemia in newborn

Background: The early diagnosis of neonatal septicemia still poses great difficulties. Early clinical symptomatology of neonatal septicemia is mimicked by a lot of other disorders affecting the newborn. To study the diagnostic value of the combination of CRP, absolute neutrophil count, band form count to the total neutrophil ratio in early diagnosis of neonatal septicemia.Methods: A total 75 babies who got admitted to Mahavir institute of medical sciences between October 2018 to September 2019 (12) months were included in the study medical college hospital in a newborn with age less than 3 days and with well-defined maternal risk factors or clinical evidence of sepsis are included in the study. In all neonates, the blood sample was collected from a peripheral vein with all aseptic precautions, before administration of any antibiotic therapy.Results: A total 20 preterm babies (62.5%) were affected by septicemia.12 full-term babies (37.5%) were affected by septicemia. The sensitivity of a lab test is defined as the proportion of infants with proven sepsis in whom the result is abnormal. Specificity is the proportion of healthy infants in whom the result is normal.Conclusions. When both CRP and band form to mature neutrophil counts were positive the sensitivity and the negative predictive value were high compared to other combinations of two.