Print

Print


Barry Spector wrote:
>
> The laboratory medicine group at our hospital  has proposed the elimination
> of band counts when obtaining a CBC.  They argue that correlation between
> technicians reading the manual slide has a poor reproducibility. To bolster
> their position they offer  a
> bibliography mostly gleaned from the pathology literature including a study
> done of acute
> febrile illness  for peds ed patients. (A.J. Clin. Pathol. 1997; 107:
> 114-121),  although I have not read it. Their argument highlights several
> points including, technicians read
> 100cells to report a band count while the new automated coulter counters
> read 10,000 cells in its readout
> including neuts, lymphs. basophils, etc. It was mentioned that
> neutrophilcounts > 75% are
> more indicative of an infectious process than band counts. I don't know a
> reference. And
> lastly, institutions with high reputation, specifically
> mentioned-MayoClinic, do not report
> band counts any longer.
> Clinicians have protested with anecdotal incidents in which the band count
> heightened
> their clinical suspicion resulting in anti microbial therapy,
> orhospitalization, or even a
> surgical procedure for appendicitis in adolescents with abdominal pain.
> They were especially concerned for the populations or neonates,
> immunocompromised
> children and adults, and the geriatric patient. My questions to the list
> are (1) have other institutions been
> involved with
> similar discussions or is this a local phenomenon. (2) are any members
> 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 cut-off
> age)?
> I look forward to a stimulating response. Thanks in advance for your
> opinions
>
> barry spector
> Susquehanna Health System, Dept. of Ambulatory Care
> The above debunks the Rochester criteria which utilizes the band count
to determine as to whether an lp is necessary in the well looking
febrile infant <3 months, ( <1500 vs. >1500 bands)
 
We also use the %bands (N < 30%) in determining the need for a septic
workup on a well looking newborn,
when a mother has predisposing risk factors for transmitting infection
to baby during labour.  I do not have references unfortunately.  I am
however aware of the variability in band count as per different
technicians as you nicely pointed out.
 
Brad
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>   http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html
 
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html