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Travis 06 04
Travis 06 04
three final diagnoses: (1) dental caries, (2) facial was: Group la, N=33; Group lb, N=36; Group 2,
lulitis secondary to dental origin, and (3) periorbital N = 40; and Group 3, N = 42.
cellulitis (dental etiology having been ruled out). Group Leukocyte count (WBCcount), erythrocyte count
1 was divided into two subgroups. Group la was (RBC count), hematocrit, hemoglobin concentration,
designated "multiple caries without, periradicular pa- mean corpuscular volume, mean corpuscular hemo-
thosis." Group lb was designated "multiple caries globin, and mean corpuscular hemoglobin concentra-
with periradicular pathoses." The subclassification was tion were analyzed by automated instrumentation in
based upon a thorough review of each patient’s den- the hospital hematology laboratory. The WBCdiffer-
tal chart. Multiple caries were confirmed through ex- ential count and the platelet count were completed
amination of full mouth radiographs and/or clinical manually by conventional smear techniques and read
charting. Periradicular pathosis likewise was con- by certified technicians.
firmed through examination of dental radiographs andY The CBCutilized for each patient was that obtained
or specific mention of single or multiple fistulas or upon admission to the hospital. Values for body tem-
parulis of dental etiology. In Groups 2 and 3, the use perature also were obtained upon admission. All val-
of the term "cellulitis" to describe each patient’s con- ues for body temperature were adjusted to an
dition upon admission to the hospital was consistent equivalent oral temperature if taken rectally or in the
8with the definition given by Schuster and Burnett.
axillary areas. 1° Control values for each of the com-
The search was terminated when the number of pro- ponent analyses comprising the CBCwere standard
spective cases in each of the four groups was 60 (N normal values for the population served by the Cin-
= 6O). cinnati Childrens’s Hospital Medical Center (CHMC).
In each group, the patient’s medical history was These values were obtained previously and apart from
reviewed. Any case with a suspected or positive his- this study by the (CHMC)hematology laboratory for
tory of hematologic disease or abnormality was ex- purposes of establishing normal CBCvalues. Veni-
cluded from the study. Also excluded were patients puncture and capillary bed blood samples were drawn
receiving antibiotic therapy and those patients re- from 100 patients 2-10 years (6.3 years mean age)
ceiving any pharmacologic agent with known he- undergoing outpatient surgery who presented in good
matologic effects. 9 Final population size for each group health with no apparent illness or infection as certi-
Control
(A) PMNs 2,520 - 6,160
(B) Lymphocytes 1,530 - 3,740
Control
(C) Monocytes 180 - 440 population
for
CHMC
(D) Eosinophils 122 - 297
(E) Basophils 22 - 55
(F) Band forms 135- 330
Group 2
(A) PMNs 4,386 - 17,548 9,574 3,422 85.O% 0.0% 40
(B) Lymphocytes 596 - 6,096 2,433 1,164 10.0% 20.0%
(C) Monocytes 176 - 1,782 746 397 80.0% 2.5%
(D) Eosinophils 0- 700 110 147 7.1% 65.0%
(E) Basophils 0- 162 17 42 12.5% 87.5%
(F) BandNeutrophils 0- 712 99 195 15.8% 82.5%
Group 3
(A) PMNs 2,400 - 23,331 10,595 5,065 83.3% 2.4%
(B) Lymphocytes 708 - 7,261 2,859 1,420 19.0% 7.1%
(C) Monocytes 0- 4,480 860 822 74.8% 9.5%
(D) Eosinophils 0- 1,370 169 288 16.7% 59.5%
(E) Basophils 0- 360 15 44 11.9% 88.1%
(F) Band Neutrophils 0- 4,256 501 1,052 28.6% 66.7%
fled by preoperative history and physical by an ex- hospital and must be completed manually by certified
amining physician. technicians.) This policy and the fact that the data in
Blood samples in Groups 2 and 3 were obtained by this study was gathered in retrospect accounts for the
venipuncture. Blood samples in Groups la and lb fact that WBCdifferential counts and platelet counts
were obtained by capillary bed sticks. Differences in were not obtainable for patients in Groups la and lb.
CBCvalues for venipuncture specimens and capillary The data were compiled and analyzed in the fol-
bed specimens are negligible with the exception of lowing manner: maxima, minima, mean, and stan-
the hemoglobin w~lue which is approximately 1 mg/ dard deviation were calculated for each CBCparameter
100cc lower in venous blood than in capillary blood. for each patient in each of the four test groups. In
The hemoglobin values collected in this study were Groups 2 and 3, absolute counts were obtained for
not adjusted for this difference due to the fact that each type of leukocyte. The absolute count for a par-
control values utilized in the study reflect hemoglo- ticular leukocyte was calculated in the manner pre-
bin values both for venous and capillary bed speci- uscribed in a standard reference text.
mens collected from a large population. Platelet counts
and WBCdifferential counts were not performed for Absolutevalue for Valuefor that par- Total
blood samples obtained from capillary bed specimens particular leukocyte = ticular cell (from x WBCx 1/100 1
in Groups la and lb unless total WBCcount exceeded in question(cells/ differential count) count
3)
mm
11,000 WBC/mm 3. It is the policy of the hematology
laboratory of CHIvICto omit WBCdifferential counts
These calculations were conducted because the dif-
on blood samples submitted unless total WBCcount ferential count alone rarely has any significant mean-
exceeds 11,000 cells/mm 3 or unless specifically re- ing without being interpreted in relation to the total
quested in doctor’s orders. Platelet counts likewise 11
WBCcount.
are omitted unless specifically requested or unless
Tests of significance utilized in this study were the
accompanied by an elevated WBCcount (greater than
t-test of the differences between two means and the
11,000). (This is because the WBCdifferential count
chi-square (x2). Statistical significance was defined
and the platelet count are not yet automated at this p~.05.12
actually exhibited band neutrophils in their individ- icant difference only between the noncellulitis groups
ual WBCdifferential counts. Because of the difference (Groups la and lb) and the cellulitls groups (Groups
between the two groups, the following hypothesis 2 and 3). The difference was significant at the .05 level
was advanced: (p~<.001).
PEDIATRIC
DENTISTRY:
December
1984/Vol.6 No. 4 2"19