I. Definitions: Left Shift

  1. Increased number of immature Neutrophils (band forms)
  2. Suggests acute inflammation

II. Characteristics

  1. Function: Primary defense against bacterial infection
    1. Phagocytizes and digests microorganisms
    2. Responds to several sources of chemotaxins
      1. Macrophage released Interleukin
      2. Basophil and Mast Cell released Histamine
      3. C-Reactive Protein Induced Complement Activation
  2. Morphology on Blood Smear
    1. Granulocyte with neutral staining on Wright Stain
    2. Nucleus with 3 to 5 lobes connected by thin chromatin
    3. Cytoplasm with fine granules

III. Interpretation: Normal Count

  1. Range: 50-70% of White Blood Cells
  2. Bands: 2-6% of White Blood Cells
  3. Absolute Neutrophil Count (ANC) >1500 Neutrophils/mm3

IV. Causes: Decreased Neutrophils

V. Causes: Increased (Neutrophilia) - ANC > 7500/mm3

  1. Physiologic Increase (Demargination)
    1. Release of cells in marginal pool
    2. Mediated by stress (Stress Leukocytosis)
      1. Exercise
      2. Seizures
      3. Anxiety
      4. Epinephrine
  2. Acute bacterial infection (and other infections)
  3. Tissue Injury and Inflammation
    1. Myocardial Infarction
    2. Burn Injury
    3. Collagen vascular disease
    4. Hypersensitivity Reaction
  4. Metabolic condition
    1. Acute Renal Failure
    2. Eclampsia
    3. Ketoacidosis
  5. Myeloproliferative disorder
    1. Myelocytic Leukemia
    2. Myeloid metaplasia
    3. Polycythemia Vera
  6. Miscellaneous causes
    1. Hemolytic Anemia
    2. Acute Hemorrhage
    3. Splenectomy (Leukocytosis may persist months)
  7. Neoplasms
    1. Metastatic cancer
  8. Medications
    1. Corticosteroids
    2. Lithium
    3. Beta agonists

VI. References

  1. Wilson (1991) Harrison's Medicine, McGraw, p. 360-1

Images: Related links to external sites (from Google)

Ontology: neutrophil (C0027950)

Definition (NCI) A type of immune cell that has granules (small particles) with enzymes that are released during infections, allergic reactions, and asthma. Neutrophils, eosinophils, and basophils are granular leukocytes. A granular leukocyte is a type of white blood cell.
Definition (MSH) Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Definition (NCI) Granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Definition (CSP) granular leukocytes having a nucleus with three to five lobes connected by slender threads of chromatin, and cytoplasm containing fine inconspicuous granules and stainable by neutral dyes.
Concepts Cell (T025)
MSH D009504
SnomedCT 80153006, 116712007, 259710001
English Leukocyte, Polymorphonuclear, Leukocytes, Polymorphonuclear, Neutrophil, Neutrophils, Polymorphonuclear Leukocyte, Polymorphonuclear Leukocytes, neutrophils, Blood neutrophil, Blood segmented neutrophil, Blood PMN, Marrow neutrophil, heterophil granulocyte, neutrophilic granulocyte, neutrophilic leukocyte, Neutrophile, Heterophile leucocyte, Neutrophil leukocyte, Neutrophil leucocyte, Blood neutrophils, POLYMORPHONUCLEAR LEUKOCYTE, Polymorphonuclear cells, polymorphonuclear leukocytes, polymorphonuclear cells, polymorph, polymorphonuclear neutrophil, polymorphonuclear cell, polymorphonuclear neutrophils, polymorphs, cells pmn, PMN, polymorphonuclear leukocyte, granular leukocyte, PMN cell, Polymorphonuclear leucocyte, Polymorphonuclear leukocyte (cell), Polymorphonuclear leukocyte, Neutrophil (body structure), Polymorphonuclear Cell, Polymorphonuclear Neutrophils, neutrophil, Polymorph, Neutrophil (cell), PMN - polymorphonuclear leucocyte, PMN - polymorphonuclear leukocyte, Polys
Dutch neutrofielen, bloed neutrofielen, Leukocyt, polymorphonucleair, Neutrofyl, Neutrofylen, Polymorphonucleaire leukocyt
French Neutrophiles sanguins, Neutrophiles, Granulocytes neutrophiles, PNN (Polynucléaire neutrophile), Polynucléaire neutrophile, Polynucléaires neutrophiles, Granulocyte neutrophile
German Neutrophile im Blut, Leukozyten, polymorphkernige, Neutrophile, Polymorphkernige Leukozyten
Italian Neutrofili ematici, Leucociti polimorfonucleari, Neutrofili
Portuguese Neutrófilos no sangue, Leucócitos Polimorfonucleares, Neutrófilos
Spanish Neutrófilos en sangre, neutrófilo polimorfonuclear, neutrófilo, neutrófilo (célula), leucocito polimorfonuclear (célula), leucocito polimorfonuclear, neutrófilo (estructura corporal), Neutrofilos, Leucocitos Polimorfonucleares, Neutrófilos
Japanese 血中好中球, ケッチュウコウチュウキュウ, コウチュウキュウ, 白血球-多形核, 多核白血球, 多形核白血球, 多形核球, LE細胞, 好中球
Swedish Neutrofila leukocyter
Czech neutrofily, granulocyty neutrofilní, leukocyty polymorfonukleární, Neutrofily v krvi, Neutrofily
Finnish Neutrofiilit
Russian NEITROFILY, LEIKOTSITY POLIMORFNOIADERNYE, GRANULOTSITY NEITROFIL'NYE, LEIKOTSITY NEITROFIL'NYE, LE-KLETKI, LE-КЛЕТКИ, ГРАНУЛОЦИТЫ НЕЙТРОФИЛЬНЫЕ, ЛЕЙКОЦИТЫ НЕЙТРОФИЛЬНЫЕ, ЛЕЙКОЦИТЫ ПОЛИМОРФНОЯДЕРНЫЕ, НЕЙТРОФИЛЫ
Croatian NEUTROFILI
Latvian Polimorfonukleārie leikocīti, Neitrofili, Leikocīti, polimorfonukleārie
Polish Neutrofile, Granulocyty obojętnochłonne, Komórki LE, Leukocyty wielojądrzaste
Hungarian Neutrofilek, Neutrofil vérszint

Ontology: Neutrophilia (C0151683)

Concepts Finding (T033)
SnomedCT 78341006, 142929007, 165518003, 414850009
English Neutrophilia, NOS, NEUTROPHILIA, neutrophilia, neutrophilic leucocytosis, neutrophilic leukocytosis, Neutrophilic leukocytosis, Neutrophilia, Neutrophilia (finding), Neutrophilic leucocytosis, Neutrophilia (disorder) [Ambiguous], Neutrophilia (disorder), Nnutrophilia
Italian Neutrofilia
Japanese 好中球増加症, コウチュウキュウゾウカショウ
Spanish Neutrophilia, leucocitosis con neutrofilia, leucocitosis neutrofílica, neutrofilia (concepto no activo), neutrofilia (hallazgo), neutrofilia, Neutrofilia, neutrofilia (trastorno)
Portuguese NEUTROFILIA, Neutrofilia
German NEUTROPHILIE, Neutrophilie
French POLYNUCLEOSE NEUTROPHILE, Polynucléose neutrophile
Czech Neutrofilie
Hungarian neutrophilia
Dutch neutrofilie

Ontology: Left shifted white blood cells (C0240173)

Concepts Finding (T033)
SnomedCT 87361006
English IMMATURE LEUKOCYTES INCREASED, LEFT SHIFT, Left shift leukocytic maturation alteration, Leukocytic maturation alteration, left shift, WBC LEFT SHIFT, Leukocytes.left shift, shift to the left, blood cells left shift white, left shift, left shift wbc, left shift of wbc, left shifting, left shifting wbc, wbc left shift, Shift to the left (haematological), Shift to the left (hematological), Shift to the left, Left shift, Left shift of WBC, Left shifted white blood cells, Left shifted white blood cells (finding)
Italian Deviazione a sinistra, Deviazione a sinistra (ematologica)
Dutch linksverschuiving (hematologisch), verschuiving naar links (hematologisch), verschuiving naar links
French Déviation à gauche (hématologique), Glissement vers la gauche
German Linksverschiebung (haematologisch), Linksverschiebung
Portuguese Desvio para a esquerda (hematológico), Virar para a esquerda
Spanish Desviación a la izquierda (hematológica), alteración de la maduración leucocítica con desviación hacia la izquierda (hallazgo), alteración de la maduración leucocítica con desviación hacia la izquierda, desviación hacia la izquierda del recuento de glóbulos blancos, recuento de glóbulos blancos con desviación hacia la izquierda, Desviación a la izquierda
Japanese 左方移動, 左方移動(血液学的), サホウイドウ, サホウイドウケツエキガクテキ
Czech Posun doleva (hematologický), Posun doleva
Hungarian Balra tolódás (hematológiai), Balra tolódás