The Diagnostic Value of Absolute Neutrophil Count, Band Count and Morphologic Changes of Neutrophils in Predicting Bacterial Infections

Abstract

Objectives: To evaluate the value of neutrophil left shift parameters and neutrophil morphologic changes in diagnosing acute bacterial infections. Materials and Methods: Peripheral blood samples were obtained from 105 patients who had a positive culture for bacteria. Automated complete white blood cell count was performed as well as peripheral blood smear preparation. Absolute neutrophil count (ANC) and neutrophil band count were determined and the neutrophils were evaluated for morphologic changes, namely toxic granulation, vacuolation and Döhle bodies. Results: Band count was less sensitive than ANC and white blood cell count in predicting bacterial infections except in the elderly and infant population. Toxic granulation in neutrophils appeared to be as sensitive as ANC in predicting bacterial infection. Conclusion: ANC and toxic granulation appear to be more sensitive than band count in predicting bacterial infections. However, band count has a greater sensitivity in infants and elderly patients.

The correlation between C-reactive protein and toxic granulation of neutrophils in the peripheral blood

“…1,3,6 However, the relationship between the intensity of TG and CRP levels has not been recognised. In our present study, the graded intensity of TG in neutrophils was evaluated using a newly designed scale which was then compared with the CRP values in patients with possible inflammatory or infectious conditions.…”

“…Controversy exists regarding the use of white blood cell quantitative parameters, and qualitative changes as indicators of acute bacterial infection. 1,3,17 Determining the intensity of TG is labour-intensive and the reproducibility is potentially poor, owing to inter-and intra-observer variability. Grading TG is dependent on technique, training and the experience of the technologist or haematologist.…”

Clinical outcomes of ED patients with bandemia

“…Some studies go further to suggest that bandemia is a superior indicator of infection relative to both WBC and temperature as bandemia was initially present in 80% of patients who did not present with elevated WBC or temperatures and were later found to be bacteremic [11]. Another study reports that the sensitivity of band counts was greater than that of either WBC or absolute neutrophil count (ANC) specifically for at-risk populations such as infants and elderly patients [12,13]. This suggests that clinicians who do not appreciate the value of band counts may have a delayed diagnosis or overlook a severe infection and thereby negatively impact patient outcomes.…”

“…However, there are currently no clinical standards by which otherwise healthy-appearing patients with isolated bandemia should be treated with antibiotics, let alone admitted to the hospital. Previous studies have focused mainly on determining whether the band count is of quantitative value; however, there is inconsistency in defining a single standard to determine what constitutes an elevated band count, with thresholds ranging from ≥5% to ≥20% [9][10][11][12].…”

The Association Between Cellular Morphological Changes in Peripheral Blood Smear and Complications in Pediatric Burn Cases

“…Kandaki C-reaktif protein seviyeleri ile doğrudan korelasyon gösteren TGN, önemli bir enflamasyon göstergesidir. [17] Al-Gwaiz ve Babay, [18] akut bakteriyel enfeksiyon olgularında, nötrofillerde-ki TGN, DC ve vakualizasyonu enfeksiyon gösterge-si olarak incelemiş ve sırası ile %78, %50 ve %37 oranında duyarlılık saptamışlardır. Çalışmamızda 22 olguda (%68,7) TGN gözlendi.…”