About the ads

  1. This site uses cookies. By continuing to use this site, you are agreeing to our use of cookies. Learn More.

bands and segs

Discussion in 'Clinical Rotations' started by justwondering, Oct 27, 2006.

  1. This forum made possible through the generous support of SDN members, donors and sponsors. Thank you.
  1. justwondering

    justwondering

    Joined:
    Aug 29, 2006
    Messages:
    269
    Status:
    Resident [Any Field]
    SDN 5+ Year Member

    SDN Members don't see this ad. (About Ads)
    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.
  2. Richie Truxillo

    Richie Truxillo Your Scut Monkey Mentor SDN Advisor

    Joined:
    Apr 26, 2004
    Messages:
    621
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    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. :smuggrin:

    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!
    [​IMG]
  3. Chronic Student

    Chronic Student So Fresh, So Clean

    Joined:
    Feb 7, 2006
    Messages:
    818
    Status:
    Non-Student
    SDN 5+ Year Member
    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
  4. Orthonut

    Orthonut Garryowen

    Joined:
    Feb 5, 2006
    Messages:
    709
    Location:
    Whisky Tango Foxtrot? Over.
    Status:
    Veterinary Student
    SDN 5+ Year Member
    Great pic...loads better than histo time.
  5. justwondering

    justwondering

    Joined:
    Aug 29, 2006
    Messages:
    269
    Status:
    Resident [Any Field]
    SDN 5+ Year Member
    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.
  6. Chronic Student

    Chronic Student So Fresh, So Clean

    Joined:
    Feb 7, 2006
    Messages:
    818
    Status:
    Non-Student
    SDN 5+ Year Member

    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
  7. Richie Truxillo

    Richie Truxillo Your Scut Monkey Mentor SDN Advisor

    Joined:
    Apr 26, 2004
    Messages:
    621
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    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. :)
  8. justwondering

    justwondering

    Joined:
    Aug 29, 2006
    Messages:
    269
    Status:
    Resident [Any Field]
    SDN 5+ Year Member
    Got it! makes a lot more sense now.
    thanks guys!
  9. Janiceps

    Janiceps

    Joined:
    Oct 7, 2012
    Messages:
    114
    Status:
    Pharmacist

    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 ?:laugh:
  10. Rendar5

    Rendar5

    Joined:
    Nov 12, 2003
    Messages:
    6,551
    Location:
    Central Florida
    Status:
    Attending Physician
    SDN 10+ Year Member
    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.
  11. Smurfette

    Smurfette smurfalicious Administrator SDN Senior Moderator

    Joined:
    Jun 6, 2001
    Messages:
    3,079
    Status:
    Attending Physician
    Physician SDN 10+ Year Member
    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.
  12. yaah

    yaah Boring Administrator

    Joined:
    Aug 15, 2003
    Messages:
    27,486
    Location:
    Fixing in 10% neutral buffered formalin
    Status:
    Attending Physician
    Physician SDN 10+ Year Member
    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: [​IMG]
  13. Richie Truxillo

    Richie Truxillo Your Scut Monkey Mentor SDN Advisor

    Joined:
    Apr 26, 2004
    Messages:
    621
    Status:
    Attending Physician
    Physician SDN 7+ Year Member
    This thread is a blast from the past for sure! :laugh:
    I got married right before residency to someone not in the medical field. I'm glad she tolerates the geek factor! :thumbup:

    yaah, you found a better pic!

Share This Page


About the ads