Acute appendicitis is one of the common surgical emergencies. It usually presents with acute migrating pain in right iliac fossa with anorexia and nausea or vomiting. Usually clinical features are augmented with Total Leukocyte Count (TLC), urine routine examination, and abdominal ultrasound to arrive at diagnosis. Study was conducted at DHG teaching hospital, Haripur from 1st July 2016 to 31st December 2016. It was an observational study and 100 patients with clinical features of acute appendicitis were included. Laboratory tests and post-operative histopathology were performed. Most of the patients were belonging to age group 21-50 years with mean age of 26.4±8.8. TLC was raised to more than 9000/cm3 in 80% cases. Statistics showed that TLC was 83.3% sensitive, 44.4% specific with PPV of 94.1% and NPV of 20% with accuracy of 80% in diagnosis of acute appendicitis. TLC is a very useful marker in diagnosing acute appendicitis especially when combined with typical clinical features and experience of surgeon. CRP and abdominal ultrasound should also be considered to further add to diagnostic accuracy.

1. B. Alam, Z. Malik, M. Ibrar, M. T. Abdullah, S. H. Waqar and M. A. Zahid, “High total leukocyte count in the diagnosis of
   acute appendicitis,” Journal of Medical Science, vol. 22, no. 2, pp. 84-88, 2014.
2. R. Menendez-Arzac, E. Cardenas-Lailson, C. A. Sanjuan-Martinez, G. Rebolledo-Lopez, S. Parraguirre-Martinez, L. Leon and
   M. P. Mata-Miranda, “Acute intestinal ischemia serum markers for the diagnosis of acute appendicitis,” Cirugia y Cirujanos,
   vol. 73, no. 6, pp. 449-452, 2004.
3. R. E. B. Andersson, “Metaanalysis of the clinical and laboratory diagnosis of appendicitis,” British Journal of Surgery, vol. 91,
   no. 1, pp. 28-37, 2004.
4. B. A. Birnbaum and S. R. Wilson, “Appendicitis at the millennium,” Radiology, vol. 215, no. 2, pp. 337-348, 2000.
5. B. M. Khan, I. Asim and S. Khalid, “Frequency of acute appendicitis in patients presenting with acute abdomen in emergency
   department: One year experience,” Journal of Rawalpindi Medical College, vol. 3, no. 1-2, pp. 35-36, 1999.
6. D. D’Abbicco, M. Amoruso, A. Notarnicola, B. Casagranda, B. Epifania and A. Margari, “Acute appendicitis: Is this common
   pathology still of interest?” Chirurgia Italiana, vol. 59, no. 2, pp. 155-170, 2007.
7. A. Siddiqi, “A comparative investigation into appendicitis,” Annals of King Edward Medical University Lahore Pakistan, vol.
   10, pp. 263-264, 2004.
8. R. B. Jaffrey, F. C. Laing and F. R. Lewis, “Acute appendicitis high resolution real time ultrasound findings,” Radiology, vol.
   163, pp. 11-14, 1987.
9. S. R. Wilson, “The gastrointestinal tract,” in Diagnostic Ultrasound, 3rd ed. New York, NY: Elsevier Mosby, 2005.
10. A. Alvarado, “A practical score for the early diagnosis of acute appendicitis,” Annals of Emergency Medicine, vol. 15, no. 5,
    pp. 557-564, 1986.
11. D. S. Smink and D. I. Soybel, “Appendix and appendectomy,” in Maingot’s Abdominal Operations, R. Maingot, M. Zinner and
    S. W. Ashley, Eds. 11th ed. New York, NY: McGraw-Hill, 2007, pp. 589-611.
12. C. Christos, S. Kostantinous, K. Nikolaos, M. Elias, I. Giorgos and L. Fred, “Appendicitis in pregnancy: A case report and a
    review of the current literature,” Clinical and Experimental Obstetrics and Gynecology, vol. 34, no. 2, pp. 115-116, 2007.
13. M. A. Mir, I. Haq and F. Manzoor, “Diagnostic Value of Total Leucocyte Count (TLC), C-reactive Protein (CRP) and bilirubin
    in patients with suspected acute appendicitis,” International Journal of Contemporary Medical Research, vol. 3, pp. 1249-
    1253, 2016.
14. M. N. Khan, E. Davie and K. Irshad, “The role of white cell count and C-reactive protein in the diagnosis of acute appendicitis,”
    Journal of Ayub Medical College Abbottabad, vol. 16, no. 03, pp. 17-19, 2004.
15. H. P. Wu, C. F. Chang and C. Y. Lin, “Predictive inflammatory parameters in the diagnosis of acute appendicitis in children,”
    Acta Paediatrica Taiwanica, vol. 44, no. 4, pp. 227-231, 2003.
16. P. W. R. Lee, “The leucocyte count in acute appendicitis,” British Journal of Surgery, vol. 60, no. 8, pp. 618-618, 1973.
17. . Miskowiak and F. Burcharth, “The white cell count in acute appendicitis: A prospective blind study,” Danish Medical
    Bulletin, vol. 29, no. 4, pp. 210-211, 1982.
18. A Naeem, S. N. Durrani, W. M. Khan and A. Zeb, “C-Reactive protein and total leukocyte count in the diagnosis of acute
    appendicitis,” Khyber Journal of Medical Sciences, vol. 8, no. 2, pp. 231-234.
19. T. Latif and M. Riaz, “The white blood cell count is not a criterion for the diagnosis of acute appendicitis,” Paper presented at
    the Proceedings of The Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Pakistan.
20. K. A. Malik, A. Khan, and I. Waheed, “Evaluation of the alvarado score in diagnosis of acute appendicitis,” Journal of the
    College of Physicians and Surgeons Pakistan, vol. 10, pp. 392-394, 2000.
21. J. S. Khan, H. Hassan and J. A. Khan, “Investigations for Acute Appendicitis: Can we rely on them?” Pakistan Journal of
    Surgery, vol. 18, no. 2, pp. 27-30.
22. S. S. Irfan and E. M. Gattu, “Clinical correlates of positive and negative cases of appendicitis,” International Surgery Journal,
    vol. 3, no. 3, pp. 1130-1133, 2016.
23. M. H. S. Shoshtari, S. Askarpour, M. Alamshah and A. Elahi, “Diagnostic value of quantitative CRP measurement in patients
    with acute appendicitis,” Pakistan Journal of Medical Sciences, vol. 22, no. 3, pp. 300-303.

J. I. Khan, M. Nawaz, N. Sultan “Role of total leukocyte count in diagnosis of acute appendicitis,” International Journal of Health and Medical Sciences, vol. 3, no. 2, pp. 50-53, 2017.