e-ISSN 2329-0072




Distribution of band neutrophils and toxic granulations in patients with severe infections

Akhil Vallabhaneni, Avanthi Doppalapudi, Kevin Gleeson

Med Sci Tech 2011; 52(1-2): RA25-27

ID: 882072

Available online:

Published: 2011-10-28

Background:    The presence of immature neutrophils (bands) and toxic granulations in peripheral blood smears has long been associated with severe infections. Bands are immature neutrophils with altered nuclear lobes; toxic granulations are defined as neutrophils with dark, basophilic granulation in their cytoplasm, which vary from fine to coarse in consistency. These changes in neutrophils are thought to represent a morphologic variation and proliferation of the cells as a defense mechanism in response to severe infection or inflammation. To our knowledge there exists no published data regarding the distribution of these modified neutrophils in infectious or non-infectious conditions.
    Material/Methods:    We designed the current observational study to evaluate the distribution of these cells in the acute inpatient setting. All patients admitted to the inpatient medical service had peripheral blood smear (PBS) performed within 24 hours of admission.
    Results:    497 patients met the inclusion criteria of having greater than 10% band neutrophils or TG on their PBS. We reviewed their medical records for initial signs of systemic inflammatory response syndrome (SIRS) and severe infection. The presence of bands was associated with a 2-fold greater likelihood of having severe infection. (OR=2.30; CI: 1.41–3.75; p<0.002). In patients with SIRS, the presence of bands was associated with a 3-fold greater likelihood of having severe infection. (OR=3.19; 95% CI: 1.41–3.75; p<0.001) In univariate or multivariate chi-square analysis, presence of TG was not significantly associated with severe infection (OR: 1.0).
    Conclusions:    In this pilot study we found that patients admitted to the hospital with greater than 10% band neutrophils on their peripheral blood smear have a substantial association with clinical evidence of severe infection. This association is stronger if patients meet criteria for SIRS.

Keywords: Bands, Toxic granulations, Sepsis, bands, Toxic granulations, severe infection