Immature Neutrophils in the Blood Smears of Young Febrile Children

Kuppermann, Nathan; Walton, Edward A.

doi:10.1001/archpedi.153.3.261

Cited by 35 publications

(20 citation statements)

References 44 publications

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“…16 PCT appears to be more accurate as a screening test for SBI than other traditional blood screening tests, demonstrated by the greater AUC for PCT. Although we also found the absolute band count to also be significant in both the bivariate and the multivariable analyses, the utility of absolute band counts in identifying children with SBI has been questioned by some, [17][18][19] while others have demonstrated that absolute band counts may vary between laboratories. 20 The management of febrile infants and young children without obvious foci of infection remains a clinical conundrum for clinicians.…”

Section: Discussionmentioning

confidence: 63%

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Mahajan

Grzybowski

Chen

et al. 2014

Academic Emergency Medicine

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Objectives: There is no perfectly sensitive or specific test for identifying young, febrile infants and children with occult serious bacterial infections (SBIs). Studies of procalcitonin (PCT), a 116-amino-acid precursor of the hormone calcitonin, have demonstrated its potential as an acute-phase biomarker for SBI. The objective of this study was to compare performance of serum PCT with traditional screening tests for detecting SBIs in young febrile infants and children.Methods: This was a prospective, multicenter study on a convenience sample from May 2004 to December 2005. The study was conducted in four emergency departments (EDs): one pediatric ED and three EDs with pediatric units, all with academic faculty on staff. A total of 226 febrile children 36 months old or younger who presented to the four participating EDs and were evaluated for SBI by blood, urine, and/or cerebral spinal fluid (CSF) cultures were included.Results: The test characteristics (with 95% confidence intervals [CIs]) of the white blood cell (WBC) counts including neutrophil and band counts were compared with PCT for identifying SBI. Thirty children had SBIs (13.3%, 95% CI = 8.85 to 17.70). Four (13.3%) had bacteremia (including one with meningitis), 18 (60.0%) had urinary tract infections (UTIs), and eight (26.6%) had pneumonia. Children with SBIs had higher WBC counts (18.6 9 10 9 AE 8.6 9 10 9 cells/L vs. 11.5 9 10 9 AE 5.3 9 10 9 cells/L, p < 0.001), higher absolute neutrophil counts (ANCs; 10.6 9 10 9 AE 6.7 9 10 9 cells/L vs. 5.6 9 10 9 AE 3.8 9 10 9 cells/L, p = 0.009), higher absolute band counts (0.90 9 10 9 AE 1.1 9 10 9 cells/L vs. 0.35 9 10 9 AE 0.6 9 10 9 cells/L, p = 0.009), and higher PCT levels (2.9 AE 5.6 ng/mL vs. 0.4 AE 0.8 ng/mL, p = 0.021) than those without SBIs. In a multivariable logistic regression analysis, the absolute band count and PCT were the two screening tests independently associated with SBI, although the area under the receiver operating characteristic (ROC) curve for PCT was the largest (0.80, 95% CI = 0.71 to 0.89).Conclusions: Procalcitonin is a more accurate biomarker than traditional screening tests for identifying young febrile infants and children with serious SBIs. Further study on a larger cohort of young febrile children is required to definitively determine the benefit of PCT over traditional laboratory screening tests for SBIs.ACADEMIC EMERGENCY MEDICINE 2014; 21:171-179

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Section: Discussionmentioning

confidence: 63%

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Mahajan

Grzybowski

Chen

et al. 2014

Academic Emergency Medicine

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“…Using only one haematologist eliminates interobserver variations that may arise in cytological interpretations and in the staining methods that are important for the recognition of neutrophil progenitors and their discrimination from one another [14,22]. Differences in procedures used to identify immature neutrophils could explain why some investigators propose that the increased levels they observed in the circulation are an indication or prediction of bacterial infections [12,13,16], whereas others suggest that these levels have limited diagnostic application [8].…”

Section: Discussionmentioning

confidence: 99%

The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation

et al. 2015

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IntroductionIn this cohort study, we investigated whether monitoring blood levels of immature neutrophils (myelocytes, metamyelocytes and band cells) differentiated patients with sepsis from those with the non-infectious (N-I) systemic inflammatory response syndrome (SIRS). We also ascertained if the appearance of circulating immature neutrophils was related to adverse outcome.MethodsBlood samples were routinely taken from 136 critically ill patients within 48 hours of ICU entry and from 20 healthy control subjects. Clinical and laboratory staff were blinded to each other’s results, and patients were retrospectively characterised into those with SIRS (n = 122) and those without SIRS (n = 14). The patients with SIRS were further subdivided into categories of definite sepsis (n = 51), possible sepsis (n = 32) and N-I SIRS (n = 39). Two established criteria were used for monitoring immature white blood cells (WBCs): one where band cells >10% WBCs and the other where >10% of all forms of immature neutrophils were included but with a normal WBC count. Immature neutrophils in blood smears were identified according to nuclear morphology and cytoplasmic staining.ResultsWith the first criterion, band cells were present in most patients with SIRS (mean = 66%) when compared with no SIRS (mean = 29%; P <0.01) and with healthy subjects (0%). The prevalence of band cells was higher in definite sepsis (mean = 82%) than in patients with possible sepsis (mean = 63%; P <0.05) or with N-I SIRS (mean = 39%; P <0.001), and they had a sensitivity of 84% and a specificity of 71% for the detection of definite sepsis. With the second criterion (that is, patients with normal WBC counts), we noted that immature neutrophils did not differentiate any of the patient groups from one another. Patients who died within 1 week of blood sample provision had higher levels of myelocytes and metamyelocytes (median = 9%; P <0.05) than patients who died at 2 to 4 weeks (median =0.5%).ConclusionsRaised blood levels of band cells have diagnostic significance for sepsis, provided that measurements are not confined to patients with normal WBC counts, whereas an increased prevalence of myelocytes and metamyelocytes may have prognostic application.

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“…Previous work with blood smears revealed a similar lack of diagnostic utility of peripheral blood band counts in distinguishing bacterial from viral infections outside the central nervous system. 14 Previous investigators demonstrated the diagnostic utility of CSF neutrophil levels in differentiating bacterial from aseptic meningitis in children. 9,12,[15][16][17][18][19] Several studies reported on the early predominance of CSF neutrophils in children with aseptic meningitis and the Ϫ2.5 (Ϫ3.8 to Ϫ1.2) Peripheral blood WBC count, mean Ϯ SD, ϫ10 9 cells per L a 17.2 Ϯ 10.2 11.5 Ϯ 4.6 5.7 (2.7-8.7) Peripheral blood ANC, mean Ϯ SD, ϫ10 9 cells per L a 12.9 Ϯ 10.0 6.4 Ϯ 4.0 6.6 (3.6-9.5) Peripheral blood band proportion, mean Ϯ SD a 0.13 Ϯ 0.12 0.02 Ϯ 0.06 0.10 (0.07-0.14) Peripheral blood ABC, mean Ϯ SD, ϫ10 9 cells per L a 2. changes in CSF neutrophil proportions and ANCs with illness duration among these patients.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Value of Immature Neutrophils (Bands) in the Cerebrospinal Fluid of Children With Cerebrospinal Fluid Pleocytosis

et al. 2009

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Immature Neutrophils in the Blood Smears of Young Febrile Children

Cited by 35 publications

References 44 publications

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

Procalcitonin as a Marker of Serious Bacterial Infections in Febrile Children Younger Than 3 Years Old

The diagnostic and prognostic significance of monitoring blood levels of immature neutrophils in patients with systemic inflammation

Diagnostic Value of Immature Neutrophils (Bands) in the Cerebrospinal Fluid of Children With Cerebrospinal Fluid Pleocytosis

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