Bandemia

Background

• Bandemia (also referred to as a "left shift") refers to an excess of immature neutrophil precursor cells (band cells)
• The origin of the phrase "left shift," is commonly thought to stem from the left-most button arrangement of early cell sorting machines
• A left shift refers SPECIFICALLY to increase bands and not increased neutrophils, which can increase in the setting of seizure, MI, pain or any stress response.

Clinical Features

• There are no clinical features specific to bandemia
• Generally defined as > 6% band cells on a CBC w/ diff

Differential Diagnosis

• Bandemia typically indicates a serious underlying inflammatory or infectious process
  • sepsis

Evaluation

• Complete history and physical
  • Look for any source of infection
  • Look for decubiti
  • Consider GU sourced in women and do a pelvic exam
  • Consider pulmonary source
  • Consider GI source such a the gall bladder

Workup

• • Blood cultures, CBC, CMP, UA, CXR if respiratory symptoms
  • Complete physical and include nurses regarding decubiti