Case Study

A 60-year-old woman was sent for preoperative blood testing before her elective gallbladder surgery. Her surgeon ordered a complete blood count, a chemistry panel, and a coagulation profile. Her chemistry panel and coagulation profile were normal. Her CBC, however, showed a large number of band forms, which were flagged on the automated differential. This was an unexpected result, and the surgeon called for a repeat sample. Because her differential was flagged, a slide was pulled and observed for a slide review. Which conditions may show a high number of bands?

Insights to the Case Study

The CBC on this individual showed all normal parameters except for the band count in the automated differential. The automated differential in this patient reported 50% bands, clearly unexpected results. Reflex testing was ordered and a peripheral smear was reviewed. The smear showed large numbers of segmented neutrophils with bilobed or peanut-shaped nuclear material, suggestive of Pelger-Huet anomaly. Pelger-Huet anomaly, discovered in 1928, is an inherited abnormality of the segmented neutrophils in which there is hyposegmentation of the nuclear material. In most cases, it is a heterozygous disorder and the white cells still function normally showing active phagocytic ability and normal leukocyte function. When the disorder presents homozygously, a single round nucleus is seen. It is essential to differentiate Pelger-Huet anomaly from true band cells because the reporting of 50% bands could lead the physician to suspect septicemia or other serious infectious conditions, which would warrant a left shift. In this case, the surgeon was notified and the surgery was completed as scheduled.

156 Part III • White Cell Disorders

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