What is the role of CBC count and other blood studies in the evaluation of peritonitis and abdominal sepsis?

Updated: Jul 23, 2019
  • Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Praveen K Roy, MD, AGAF  more...
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Most patients will have leukocytosis (>11,000 cells/μ L), with a shift to the immature forms on the differential cell count. Patients who have severe sepsis, are immunocompromised, or have certain types of infections (eg, fungal, cytomegaloviral) may not have leukocytosis or leukopenia. In cases of suspected spontaneous bacterial peritonitis (SBP), hypersplenism may reduce the polymorphonuclear leukocyte count.

Blood chemistry findings may reveal dehydration and acidosis. Obtaining prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) is indicated. Liver function tests may be indicated. Amylase and lipase levels should be obtained if pancreatitis is suspected. Blood culture results are positive for the offending agent in as many as 33% of patients with SBP and may help guide antibiotic therapy. Measurement of serum albumin allows calculation of the serum-to-ascites albumin gradient (SAAG). A SAAG of more than 1.1 is noted in SBP.

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