My attending had this 90 something female with fever ; TMAX 103 x 3 days, AMS, no obvious source, and while waiting for labs/CXR to come back I took a peek at the CBC which showed a WBC of 9.4, and a Neutrophil % in the 80s-90s. I asked if this was significant, as she may not be able to mount a white count secondary to her age/comorbidities (which I don't remember). He said the neutrophil count is worthless and Bands would be more indicative, although our labs doesn't check for bands unless the WBC is high.
I always thought (as a guideline, not the law), that a high N% may mean bacterial infx, L% viral, Eosinophil% parasitic/allergic, and felt that this woman possibly couldn't mount a white count, but her diff was significant. I mean we still drew cultures and checked for a source, but I guess my quesiton is how important is the diff? How should I approach it and how much emphasis should I place on it? While we're on the subject, how do you approach bandemia and how serious is it really?
Thanks in advance!
I always thought (as a guideline, not the law), that a high N% may mean bacterial infx, L% viral, Eosinophil% parasitic/allergic, and felt that this woman possibly couldn't mount a white count, but her diff was significant. I mean we still drew cultures and checked for a source, but I guess my quesiton is how important is the diff? How should I approach it and how much emphasis should I place on it? While we're on the subject, how do you approach bandemia and how serious is it really?
Thanks in advance!