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?
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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