barry spector wrote
My questions to the list
are (1) have other institutions been
similar discussions or is this a local phenomenon. (2) are any
using band counts in their
evaluation of the febrile child <36mo. and if so, what would be
yourresponse (3) would
you require continued band counts for neonates or <3mo.(pick a
The absolute band count (1500) has been described as one of the criteria
in the Rochester and Milwaukee criteria for stratifying infants between
1-3 months as "low risk" to potentially manage as an outpatient.
In addition, the I/T ratio of > 0.2 is a marker for sepsis/NEC in the
evaluation of a febrile neonate.
In the febrile patient 3- 36 month without a source I don't believe the
band count offers any additional value when compared to a TLC. However,
what about smears with intra neutrophilic toxic granulations and Dohle
bodies? These do seem to corelate with bacteremia with or without
sepsis. If the manual component is eliminated we would loose this part
of the peripheral smear evaluation too.
In the Mantrell's scoring system for appendicitis a left shift
with/without an elevated white count enhances likelihood of the
Bandemia with bloody diarrhea may be Shigella enterocolitis.
In summary, I am NOT as an ED physician ready to support the ban on
doing band counts. I rest my case!
Could you share some more information on the Mayo clinic rationale for
" shoot straight now "
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