Download Bandemia - Alyson Paige Lozicki

Bandemia Alyson Lozicki and Martina Prusac, PharmD Candidates 2017, USF College of Pharmacy Preceptor: Gwendolyn Wantuch, PharmD, BCPS In the simplest terms, bandemia (also referred to as “left shift”) occurs when the number of bands present exceeds the reference range. Bands are immature neutrophils, and neutrophils ​are the body's primary defense against bacterial infection and physiologic stress; normally, most of the neutrophils in circulation are mature (segs). In disease states that require an increased number of neutrophils both the segs and bands are increased, but because there is only a limited percentage of neutrophils that are stored as segs, the percentage of bands will increase as they are released to boost the total neutrophil count. ​1 Laboratory findings of bandemia frequently prompt the initiation of empiric antibiotics for a suspected infection. In many cases this is an accurate course of action, but bandemia is not exclusively the result of an infection, and it is important to consider the whole clinical picture of a patient before initiating antibiotics (especially if there are no additional signs of infection). The significance of bandemia at face value is to indicate that a patient has a severe systemic illness, but this may be of infectious, inflammatory, or metabolic origin. ​2,3 Noninfectious disease states that can cause an increase in bands: Severe hemorrhage Metabolic acidosis Inflammatory processes (collagen vascular disease, hypersensitivity reactions, gout) Seizures Intoxication Anoxia Pancreatitis Cancer Significant tissue trauma (necrosis) Corticosteroid use Some viral infections Severe autoimmune disorders Determining the cause of bandemia is difficult and requires a great deal of scrutiny of the CBC­diff findings. The band count has limited utility in the diagnosis of infection in sick, hospitalized patients, who are likely to have bandemia associated with another underlying illness or medication. Additionally, bandemia cannot distinguish between a bacterial and a viral infection. Differentiation between band and segmented neutrophils is problematic from the start because there is a lack of a consistency in the definitions themselves, and because the process of differentiation is so subjective. As a result there are several reference ranges suggested in literature. ​3 There is currently no adequate alternative to using band count in the diagnosis of an infection. A look into clinical signs and symptoms of infection, and evaluation of other inflammatory markers provides clinicians with additional insight into the cause of bandemia. However, an optimal combination of these markers has not yet been defined, so employment of clinical judgement is critical in making a diagnosis. References: 1. ADAM, Inc. Blood differential test. MedlinePlus website. https://medlineplus.gov/ency/article/003657.htm. January 27, 2015. Accessed July 13, 2016. 2. Spellberg B. Clarifying Bandemia. ​
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