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
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