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Stepwise Success

Do You Still Report Bands?

Published December 12, 2012 6:00 AM by Scott Warner

It was not very long ago that I heard “What’s the band count?” It seemed commonplace for surgeons to decide to operate on the basis of them. ED physician assistants and doctors waited for them, too. And don’t get me started on pediatricians.

In the laboratory, we saw (and continue to see) enormous variation in counting and reporting band counts. Some of this is caused by statistical imprecision inherent with 100-cell differentials. However, there are significant differences in perception and no happy consensus of what a “band” is:

Bands are the same size or slightly smaller than metamyelocytes. The nucleus is centrally or eccentrically placed and indented to more than half the distance from the farthest nuclear margin. The nucleus may appear in the shape of a band, sausage, letters C or U, or may be lobulated. If lobulated, the bridge or isthmus between the lobes must be wide enough to have two distinct parallel dark margins with light nuclear material in between.

Can’t imagine why bench techs would play the is-it-or-isn’t-it game.

Automated accuracy has been moving labs away from reporting bands in recent decades. While an elevated band count represents a “shift to the left” (immature neutrophils), it is a less specific indicator for infection than an absolute neutrophil count. It may be secondary to inflammation, tissue damage, neoplasms, metabolic abnormalities, etc. This and the count’s ingrained imprecision have discouraged reporting bands.

As one 2002 article points out, “the clinical folklore of the band persists despite little mention of its diagnostic utility in current textbooks. Textbooks in internal medicine, hematology, and laboratory medicine do not recommend band counts for the diagnosis of infection, other than to mention that neutrophilia and left-shift typically accompany infection or inflammation.”

I wonder. Are bands still a useful part of the clinical picture? They are nonspecific but still markers of a left shift. I have a sense that in large enough numbers they are a hint that something is happening but also that reporting them will mislead some physicians.

What about your lab? Do you still report bands?

NEXT: The Lab Did It

2 comments

Ashiq,

I asked one of our physicians about bands just the other day. He said, "I want to see them, but I don't pay much attention to them." I agree that bands indicate some kind of stress and add something to the clinical picture. Question is, what?

That sounds like a physician education issue. It's up to the clinician to interpret, as you say.

Scott Warner January 7, 2013 7:18 PM

Yes we do ,I believe that counting bands is very important for the clinician to give him a true picture of the maturity of the leukocytes because if there are too many bands present in the peripheral circulation ,it means bone marrow is stressed due to what ever reason . Clinician might be able to think about more specific testing for the increase cause of bands in the circulation . Left shift ....How will we know if there is a left shift or not if we do not count Bands.%0d%0aThank you.%0d%0aAshiq Hussain MT H(ASCP)

Ashiq Hussain, Clinical Laboratory - Supervisor, STAT December 29, 2012 7:05 PM
Herndon VA

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About this Blog


    Scott Warner, MLT(ASCP)
    Occupation: Laboratory Manager
    Setting: Critical Access Hospital
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