Normal Reference Interval of WBC Count After On - Pump Coronary Artery Bypass Graft; When Values Could Be Misleading

BACKGROUND: Applying the cardiopulmonary pump produces inflammatory responses and induces leukocytosis. White Blood Cell (WBC) count has a diagnostic value for detecting different infections. In this study, we want to redefine the normal value reference intervals of WBC count in Coronary Artery Bypass Graft (CABG) patients, to prevent misdiagnose leukocytosis as a sign of infection. METHODS: In an observational study, 140 patients who underwent on - pump CABG were enrolled to find out normal values of the reference interval. WBC counts were evaluated for all of them one day before the operation, first 30 minutes of ICU entrance, after 24 hours, and 48 hours after operation. Normal values of reference intervals were calculated for each measurement by two different statistical methods. RESULTS: There were 102 men and 38 women with age average of 61 years. There was no significant difference between genders’ WBC counts before operation (P = 0.151), ICU entrance (P = 0.391), 24 hours after surgery (P = 0.698), and 48 hours after surgery (P = 0.523). The mean values of WBC after surgery were higher than the normal range of reference interval and had an increasing trend in the first 48 hours after surgery. The WBC values were significantly different between pre and post operation (before operation and ICU admission (P = 0.001), ICU admission and 24 hours later (P = 0.001), 24 hours after surgery, and 48 hours after surgery (P = 0.001)). All post - operative reference values were significantly higher than the range for the general population. CONCLUSIONS: There is a significant increase in WBC count after on - pump CABG. The normal range of WBC should be revised and adjusted to prevent misinterpretation as a sign of infection.