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 with differential

Differential Diagnosis

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

Evaluation

• Complete history and physical
  • Look for any source of infection
    • Consider decubitus ulcers
    • Consider GU sources in women and young uncircumcised boys
    • Consider pulmonary source
    • Consider GI source including gallbladder

Workup

• Blood cultures, CBC, CMP, UA, viral swabs, CXR if respiratory symptoms
• Complete physical exam