Increased bands in CBC?

[anbuitachi]

Can someone explain to me the difference between increased bands w/o toxic granulations/duole bodies, and one with those?

My attending looks at it, sees bands of like 25%, but no toxic granulations.. and just goes whatever.. he only cares about toxic grans.. As far as I know toxic granulation is a sign of inflammation commonly found in sepsis. But doesn't increased bands suggest that as well?

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[Bacchus]

http://books.google.com/books?id=3PJVLH1NmQAC&pg=PA820&lpg=PA820&dq=bandemia toxic granulations&source=bl&ots=tstG83OLnU&sig=bY00Oyg4W7v3-Mh2ocPZ2vQ4pyI&hl=en&sa=X&ei=OqvXUqi_IpOLkAfN_IDADw&ved=0CCgQ6AEwAA

Somewhat enlightening. Most of my attends at least want to know the number of bands if I'm reporting an elevated white count.

 

[cmz]

Make sure that you're actually dealing with true band cells. As a hematopathologist, I have seen A LOT of over-called band cells by lab techs, residents, non-pathologists, and pathologists alike. Without reviewing the peripheral smear yourself, you may fall into the trap of taking whomever reviewed the smear on their word.

http://www.cap.org/apps/cap.portal?..._band.html&_state=maximized&_pageLabel=cntvwr

 

[Psai]

Bumping for question, so when exactly do you call something a left shift or bandemia? I'm wondering if there's a certain percentage or is it if you have a leukocytosis with any bands present

 

[cmz]

Blasts -> Promyelocytes -> Myelocytes -> Metamyelocytes -> Bands -> Segmented neutrophils (This is the natural progression from earliest progenitor cell to the final mature state)

To me, "Left shifted" means I am seeing early granulocyte precursors (e.g. blasts, promyelocytes, myelocytes, metamyelocytes) out in the peripheral blood.

When I call something "left shifted" I like to qualify what I am seeing. I may say, "left-shifted leukocytosis, including occasional myelocytes and metamyelocytes". Usually, a differential cell count will be provided either by the lab tech or pathologist. To me, there's no such thing as a cut-off percentage for reporting a left-shift. You have to interpret this in the appropriate clinical context. Sure, if you look at a gazillion peripheral smears, you will undoubtedly find a rare, circulating blast cell in an otherwise normal individual's peripheral blood. If you find that you're seeing a significant number of immature granulocytes on the differential, then you know that you're dealing with a left-shift.

Leukocytosis has nothing to do with whether there is a left-shift or not. Leukocytosis simply means elevated WBC. Often times, when you have a leukocytosis, you will probably notice at least a mild left shift. Sometimes, you may not. What if you had a CBC that showed a WBC of 17K with a differential of 92% lymphocytes? Obviously, this patient has a leukocytosis and we know that this is primarily due to the increased numbers of lymphs (more specifically qualified as a lymphocytosis). There was no mention of left shift in that example.

 

[Psai]

What would you call a bandemia then?

 

[cmz]

What would you call a bandemia then?

An excess of bands in the peripheral blood? Having a left-shift or having a so called "bandemia" offer up a differential that you have to piece together with other clinical information.

 

[pd1112]

What would you call a bandemia then?

What I've seen most commonly is >5% on the diff.