Determining "true" leukocytosis in bloody joint aspiration

J Arthroplasty. 2008 Feb;23(2):182-7. doi: 10.1016/j.arth.2007.08.016.

Abstract

This study intends to determine the diagnostic value of implementing a corrective formula that can adjust for serum leukocytes in bloody joint fluid. Our cohort included 91 infected and 37 aseptic total knee arthroplasties. Joint fluid leukocyte count (>1760/microL) and neutrophil percentage (>73%) were the cutoff values for deep infection. The adjusted fluid leukocyte counts were calculated using the following simple formula: WBCadjusted=WBCobserved-[(WBCblood x RBCfluid/RBCblood)]predicted. Adjusted fluid cell counts of only 5 infected patients dropped below the cutoff value, whereas the remaining 86 maintained a high cell count. Ten noninfected patients had false-positive cell counts, 6 of which were successfully corrected to levels below the designated thresholds. The aspirates that were corrected had a greater number of introduced white blood cells. This study suggests that our corrective formula can detect false-positive joint aspirations without jeopardizing the diagnosis of periprosthetic infection.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Arthroplasty, Replacement, Hip*
  • Exudates and Transudates / cytology
  • False Positive Reactions
  • Female
  • Humans
  • Leukocyte Count / methods*
  • Leukocytosis / diagnosis*
  • Male
  • Postoperative Complications
  • Prosthesis-Related Infections / diagnosis*