“Bands” are immature neutrophils and are checked as part of “CBC with differential”. They are so called since their nucleus is still just a band & not matured into lobules yet. When their numbers are significant (bands > 10%, higher the worse), it means the body is urgently drafting young WBCs to prepare for impending sepsis or inflammatory insult – they are kinda like the lightening before a storm, an early warning sign – aka “Sh*t’s about to go down”. But hey don’t take my word for it, let’s look at some studies.
A retrospective study in 2012 found patients with significant bandemia had increased odds of a postive blood culture despite a normal WBC count. A letter published after this study in 2012 reports a case of pancreatitiss who was discharged after clinical improvement despite CBC showing 24% bands (but normal WBC). Patient was readmitted 12 hours later with hemorrhagic pancreatitis. A 2015 study of patients discharged from ED with active bandemia showed severely bandemic patients had 5 times greater mortality compared to nonbandemic ones ! A more recent retrospective review of Bandemia published in 2022 also found the incidence of bacteremia was significantly higher in cases with bandemia (52.3% with v/s 13.3% without).
Medical malpractice lawsuits can be very educational. Here’s an unfortunate case of a patient seen in ER for nausea & emesis after a recent C-Section. She had a normal WBC count but 65% bands ! She was sent home after IV fluids & symptom control. A few days later she ended up in septic & hemorrhagic shock from bowel perforation sustained on prior C-Section and died. Another case “May v. North Shore University Hospital” where a patient on peritoneal dialysis was discharged after treatment for bacterial peritonitis & returned with severe sepsis in DIC & died. The expert physician testifying noted that she was previously discharged with just a CBC-check without differential despite bandemia seen some days prior. In a court of law, objective evidence on labs and what you document can trump medical judgement.
đź’ˇ So mull on this while enjoying your next coffee – Always look closely at the differentials on CBC. If you see significant bandemia despite normal WBC, let it remind of you the band playing on the sinking titanic . Think hard about anything else you might be missing or give it more time before deeming your patient safe to discharge.
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