Hi everyone,

 

I am working on consistancy on manual differentials, especially on the bands. Looking for advice, education options, guidelines, pictures that have the cell labeled, any procedures. Thanks!

 

_{Unless it has changed recently, I believe the general consensus on band counts is that they provide almost no clinical information that is not already available with the rest of the CBC/Diff and morphology review. We don't worry too much about them here.}

 

_{Having said that, I would think you could just pick any textbook or internet source for the definition of a band and have everyone use that.} 

 

_{The most common definition that I have seen has to do with the narrowist part of the nucleus.  If it is greater than half of the long diameter of the nucleus, it is probably a metamyelocyte.  If that part is so narrow that no chromitin/parachromitin pattern can be discerned, it's a PMN.  If it's in between those two, then you have a band.}

 

_Scott

There are only two occasions that  band forms are of any significance are in men who have Barr Bodies visible - 1) it indicates the possibility of the person being 47XXY (or 47XXX if female - two Barr bodies will be present), or 2) in the case of a myeloma that is due to an X-related chomosomal translocation.

 

I always check out the Barr Bodies in left shift if the neuts are raised.

WBC Differential /Band cell counts:

Suggest review these publications:

CAP survey 1995 Lab Hematol 1,89 - Inter and Intra observer consistency

Eur J Haematol 2006:76: 251-254. Good article Re variation of WBC Diff with a number of morphologist review digital images

ISLH recent publication June 2015: ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features - which recommends that band cells be counted with neutrophils (Also directs to an image library)

I would question the value of this enumeration in the 21st cent., also consider the significant variation (LoU) of band cell counting..

Our local evaluation with digital images, gave a LoU of > 40% (Which is a good result!), hence we do not report bands cell counts, but will only make a comment.

Thank you for the input and the article links! Those are very helpful reads!!!