THE WHITE BLOOD-CELL RESPONSE TO SPLENECTOMY AND BACTEREMIA

The aim of this study was to determine the relationship of the white b lood cell (WBC) count to bacteraemia, and the risk of bacteraemia afte r splenectomy. The case series study was carried out at the Vanderbilt University Level I Trauma Center, and included 11870 consecutive trau ma admissions: 258 required a splenectomy (191) or splenorrhaphy (67). Bacteraemia was defined as the presence of a positive blood culture. Statistical analysis included ANOVA, the non-parametric Kruskal-Wallis test and logical regression. Forty-two (22 per cent) of the splenecto my patients had positive blood cultures, while only six (9 per cent) o f the splenorrhaphy patients had positive cultures. For the group of p atients requiring a splenectomy, the mean WBC count was higher and mor e persistent in patients with bacteraemia. Logistical regression demon strated that the type of surgery does not significantly correlate with bacteraemia after accounting for severity of injury (TRISS). The stud y conclusions were as follows (1) for the group of patients with bacte raemia after splenectomy, the peak WBC count was higher and more persi stent than that which occurred in the group of patients without bacter aemia after splenectomy; (2) the WBC count cannot be used to predict b acteraemia for an individual patient, but a WBC count greater than 20 000 after 10 days should initiate a vigorous search for infection; (3) the severity of injury (and not splenectomy/splenorrhaphy) accounted for the increased risk of bacteraemia in population studied,