Bandemia Overview



Normal: < 1%

Clinically significant: > 10%



Band neutrophils are slightly less mature than segmented neutrophils and have indented, unsegmented "C" or "S" shaped nuclei.

Band neutrophils normally account for approximately 5-10% of peripheral blood leukocytes.



Left Shift:

 • Cell population has "shifted towards immature precursors"

 • Stab cell - nucleus looked like a Shepard’s crook (Stab in German)

 • Neutrophils counted left to right with bands being on the left



Myeloblast → Promyelocyte → Myelocyte → Metamyelocyte (Left Shift) → Segmented Neutrophil (Normal)



Differential Diagnosis:

 • Seizures

 • Toxic ingestions

 • Metabolic abnormalities

 • Inflammatory processes

 • Tissue damage

 • Leukemia

 • Corticosteroid use

 • Autoimmune diseases

 • Chemotherapy



Even with normal WBC, patients with moderate and high BANDemia on admission had significantly increased odds of having positive cultures, including blood cultures and of in hospital mortality.

https://www.amjmed.com/article/S0002-9343(12)00450-0/abstract



BANDemia is highly predictive of a serious infection, suggesting that clinicians who do not appreciate the value of band counts may delay diagnosis or overlook severe infections.



Degree of bandemia, especially in the setting of concurrent tachycardia or fever, is associated with greater likelihood of negative clinical outcomes.

https://www.sciencedirect.com/science/article/abs/pii/S0735675715001795



Bandemia is a superior indicator of infection relative to both WBC and temperature.

 • Abnormal temperature (hypo/hyperthermia) had a sensitivity of 67% for culture proven bacteremia

 • Abnormal WBC count had a sensitivity of 48% for culture proven bacteremia

 • Bandemia had a sensitivity of 82% for culture proven bacteremia

 • In patients with bacteremia and hypotension or septic shock, 33% had normal temperature and 21% had normal WBC count on initial evaluation

 • doi.org/10.1016/j.jemermed.2010.05.038



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