“Bands” are checked as part of “CBC with differential” blood test. What are bands & why call them bands? They are immature Neutrophils – a type of our protective white blood cells (WBCs) – and are called ‘bands’ because their nucleus hasn’t matured into lobules yet and looks very band-like. They are seen normally but if their numbers are high (bands > 10% of total WBC), we call it ‘Bandemia’. Increased bands can mean the body is urgently recruiting young WBCs to prepare for impending war on septic infection or any inflammatory insult. Thus they can be an early warning sign – lightning ⚡ before a storm!
A 2012 study found that patients with significant bandemia had increased odds of a positive blood culture for infection despite a normal WBC count. A letter published after this study in 2012 reports a case of pancreatitis who was discharged after clinical improvement despite CBC showing 24% bands (but a normal WBC count!). This patient ended up being readmitted 12 hours later with hemorrhagic pancreatitis. A 2015 study of patients discharged from ED showed that 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 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 right before she was discharged. 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.
💡 So mull on this while enjoying your next coffee – give those bands a close look on differentials on CBC. If you see significant bandemia despite normal WBC, let it remind of you the band playing on the sinking Titanic, coz’ Sh*t might be about to go down ! 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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