Determining "true" leukocytosis in bloody joint aspiration.
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.
New answer by at Harvard Medical School (December 15, 2020)
Love the question as this does come up rather regularly in practice! I do adjust the synovial fluid white blood cell count for the presence of red blood cells that have made t...