bands and segs

[justwondering]

what r they?
i have a hard time determining (while looking at the cbc/diff) when the pts have bands and segs. i dont think they're usually labeled as such.

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[Richie Truxillo]

Band cells (also sometimes called "stabs" in some places) are immature neutrophils.

They can appear in large numbers when patients have a chronic infection or inflammatory process. (example: When the body is trying to crank out as many neutrophils as possible to continue fighting a chronic bacterial infection). I'd give you a more specific Differential list but it would range all the way from Acute appendicitis to Myelodysplastic syndrome all the way down to steroid-resistant Weber–Christian disease.

Segmented Neutrophils (Segs) are the mature neutrophils...all decked out and ready to get their phagocytosis on.

So if you have a White blood cell count, a segs percentage and a bands percentage...you can use a simple formula to calculate the "Absolute Neutrophil Count (ANC)" which is useful for a variety of things such as monitoring the administration of colony stimulating factor or assessing a patient's risk of infection during administration of chemotherapy.

Ok back to work I go Good luck to ya on your rotation.

-Richie

And we'll find you a picture here too....TADA!

 

[Chronic Student]

Richie, as a former med tech I'd like to point out that...

Um, well...

That there was nothing to complain about in that explanation.

In fact, that was probably one of the best, most concise explanations I've come across and a heck of a lot better than I ever got in two semesters worth of hematology.

-Mike

 

[Orthonut]

Great pic...loads better than histo time.

 

[justwondering]

hmm...
our hospital's "diff" includes
lymph
mono
gran
eo
baso

both number and %

so.... im still confused. no literal mention of bands/segs. what am i forgetting? grans are bands? what abt the segs? i dunno.

 

[Chronic Student]

hmm...
our hospital's "diff" includes
lymph
mono
gran
eo
baso

both number and %

so.... im still confused. no literal mention of bands/segs. what am i forgetting? grans are bands? what abt the segs? i dunno.

Allright,

A "diff" or differential gives you the relative and absolute numbers of the different types of white cells. You are looking for an abnormal increase or decrease in the different types.

For instance, if you have an increased white count and your percentage of neutrophils (AKA, granulocytes, segs, PMN's, etc) was 95% than you may consider bacterial infection or maybe the patient is on steroids, etc. If you saw that the percentage of lymphs was increased consider viral infections, leukemia, etc. if you see that the eo's are increased consider parasitic infection or allergic reaction, etc. You must also consider whether or not there is an increase in the absolute count vs. the relative count.

Ex. 95% neutrophils with a 5,000 WBC count vs. 95% neutrophils with a 100,000 WBC count represent two very different pathologies.

As for the seg/ band issue: they are both neutrophils/granulocytes in different stages of maturation. As they mature the nucleus goes from a more round shape in the bone marrow and start to form more of a horseshoe shape, which is called a band. As maturation continues they start to form segments and generally have four lobes (range 3-5) generally greater than five lobes denotes "hypersegmentation" and may mean megaloblastic anemia, infection or some other things.

Generally, when granulocytes are released from the storage pool into circulation they have reached the stage of maturity where they are segmented and bands should not be found in any great numbers in the peripheral blood. If they are, it means that they are being released from the storage pool early for some reason or another. Whether that is infection or due to some other reason, is something that should be investigated.

Sorry, not a very concise explanation!

-Mike

 

[Richie Truxillo]

Richie, as a former med tech I'd like to point out that...

Um, well...

That there was nothing to complain about in that explanation.

In fact, that was probably one of the best, most concise explanations I've come across and a heck of a lot better than I ever got in two semesters worth of hematology.

-Mike

Appreciate the compliment Mike. Your explanation is well written and concise considering the breadth of the question he asked.


To justwondering: The "Granulocytes" listed on your hospital's CBC are both your bands ("immature" neutrophils) AND your segs (segmented "mature" neutrophils) lumped together since they are both granulocytes. If you need a break down of segs and bands, you'll probably have to write a special order for it when ordering a CBC with manual differentiation.

I think when I finish redesigning my website I am going to try and put up some educational stuff for med students to look at. Might be a good review for me and beneficial to some people.

 

[justwondering]

Got it! makes a lot more sense now.
thanks guys!

 

[Janiceps]

Band cells (also sometimes called "stabs" in some places) are immature neutrophils.

They can appear in large numbers when patients have a chronic infection or inflammatory process. (example: When the body is trying to crank out as many neutrophils as possible to continue fighting a chronic bacterial infection). I'd give you a more specific Differential list but it would range all the way from Acute appendicitis to Myelodysplastic syndrome all the way down to steroid-resistant Weber–Christian disease.

Segmented Neutrophils (Segs) are the mature neutrophils...all decked out and ready to get their phagocytosis on.

So if you have a White blood cell count, a segs percentage and a bands percentage...you can use a simple formula to calculate the "Absolute Neutrophil Count (ANC)" which is useful for a variety of things such as monitoring the administration of colony stimulating factor or assessing a patient's risk of infection during administration of chemotherapy.

Ok back to work I go Good luck to ya on your rotation.

-Richie

And we'll find you a picture here too....TADA!

Dr. Rich, you are simply Awsome. I practice in Oncology and never heard seg and bands explained in such a beautiful fashion.
oh by the way, you must get alot of women. don't you ?

 

[Rendar5]

A lot of labs only mention %bands only if there are a significant number of such, and then that may only be on a manual diff, not an automated diff.

 

[Smurfette]

A lot of labs only mention %bands only if there are a significant number of such, and then that may only be on a manual diff, not an automated diff.

This.

Bands are usually reported only if present. However, I've never known a hospital to require a separate order to check a band count...I've always seen it automatically reported with the diff.

 

[yaah]

Bands should be automatically reported, as should any type of immature neutrophil (metamyelocyte, myelocyte). If there are none you might not get a "0" it just might not be mentioned. Labs can vary on this though. Automated diffs will not report bands because automation relies on light scatter and such, not a visual estimate, and bands are essentially identical to segmented neutrophils in these matters. All labs should have criteria for doing a manual review of slides with any abnormalities that would lead to reporting of bands though, which include any increase in neutrophils (or decrease).

FYI the definition of "band" sounds rigorous but it is not. It is essentially up to the interpretation of whoever is reviewing the slide. For example, the cell in the image posted in the upper right of that triad of three neutrophils is not obviously a band. I would probably call that a seg because the chromatin is condensing and segmenting and it isn't clear that those aren't three lobes folding over. The one at the top is a better example, but still not great.

This is a better example that I doubt anyone would argue with:

 

[Richie Truxillo]

Dr. Rich, you are simply Awsome. I practice in Oncology and never heard seg and bands explained in such a beautiful fashion.
oh by the way, you must get alot of women. don't you ?

This thread is a blast from the past for sure!
I got married right before residency to someone not in the medical field. I'm glad she tolerates the geek factor!

yaah, you found a better pic!

 

[shanlo]

Just wanting to post something that might be of use. Latest blood work...all manual differentials:
These are my latest white blood cells: Basophil----0
Eosinophil---1
Lymphocyte--17
Monocytes--7
Neutrophil--55

 

[shanlo]

Just wanting to post something that might be of use. Latest blood work...all manual differentials:
These are my latest white blood cells: Basophil----0
Eosinophil---1
Lymphocyte--17
Monocytes--7
Neutrophil--55
All within normal ranges except:

BANDS--20 (very high)

I have CMML (Chronic myelomonocytic leukemia) I am assuming the bands are found on my messed up monocytes?? Took 5 years of being told nothing to worry about even though platelets ran anywhere from 70 to 110.

Anyway, just hoping to this might help.

 

[Tapoona]

The Med Tech in me loves this thread. Or hates it because it brings back memories of doing manual diffs...