II. Definitions

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

III. Characteristics

  1. Forms in Bone Marrow from Myeloblasts as with other Granulocytes (Basophils, Eosinophils, Monocytes)
  2. 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
  3. 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

IV. 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

V. Causes: Decreased Neutrophils

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

  1. Acute Bacterial Infection (and other infections)
  2. Reactive Neutrophilia (Physiologic Increase, Demargination)
    1. Release of cells in marginal pool
    2. Mediated by stress (Stress Leukocytosis)
      1. Exercise
      2. Seizures
      3. Anxiety
      4. Epinephrine
      5. Tobacco use
      6. Post-operative state
  3. Tissue Injury
    1. Myocardial Infarction
    2. Burn Injury
    3. Hypersensitivity Reaction
  4. Chronic Inflammation
    1. Rheumatic disease
    2. Inflammatory Bowel Disease
    3. Vasculitis
    4. Chronic Hepatitis
  5. Metabolic condition
    1. Acute Renal Failure
    2. Eclampsia
    3. Ketoacidosis
  6. Myeloproliferative disorder
    1. Myelocytic Leukemia
    2. Myeloid metaplasia
    3. Polycythemia Vera
  7. Miscellaneous causes
    1. Hemolytic Anemia
    2. Acute Hemorrhage
    3. Splenectomy (Leukocytosis may persist for months)
    4. Immune Thrombocytopenia
  8. Neoplasms
    1. Metastatic cancer
  9. Congenital
    1. Down Syndrome
    2. Leukocyte adhesion deficiency
  10. Medications
    1. Corticosteroids
    2. Lithium
    3. Beta agonists
    4. Epinephrine
    5. Colony-Stimulating factors

VII. Evaluation: Neutrophilia (Neutrophils >7000/mm3)

  1. See Leukocytosis
  2. Consider history and potential causes
    1. Travel and contagious contacts
    2. Social history
    3. New medications
  3. Diagnostics (consider)
    1. Infection source evaluation
      1. Urinalysis
      2. Chest XRay
      3. Lumbar Puncture
      4. Blood Cultures (2 sets or if SBE suspected, 3 sets)
    2. Acute phase reactants
      1. Erythrocyte Sedimentation Rate (ESR)
      2. C-Reactive Protein (C-RP)
      3. Procalcitonin
    3. Other labs
      1. Rheumatologic studies (e.g. Antinuclear Antibody)

VIII. References

  1. Wilson (1991) Harrison's Medicine, McGraw, p. 360-1
  2. Riley (2015) Am Fam Physician 92(11):1004-11 [PubMed]

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Ontology: neutrophil (C0027950)

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 (NCI_NCI-GLOSS) A type of immune cell that is one of the first cell types to travel to the site of an infection. Neutrophils help fight infection by ingesting microorganisms and releasing enzymes that kill the microorganisms. A neutrophil is a type of white blood cell, a type of granulocyte, and a type of phagocyte.
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 (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 259710001, 80153006, 116712007
LNC LP16686-5, LP14267-6, LP17840-7, MTHU044811, MTHU006207, MTHU009212
English Leukocyte, Polymorphonuclear, Leukocytes, Polymorphonuclear, Neutrophils, Polymorphonuclear Leukocyte, Polymorphonuclear Leukocytes, heterophil granulocyte, neutrophilic granulocyte, Neutrophil, Neutrophile, Heterophile leucocyte, Neutrophil leukocyte, Neutrophil leucocyte, Blood neutrophils, polymorphonuclear leukocytes, polymorphonuclear cells, polymorph, polymorphonuclear neutrophil, polymorphonuclear cell, neutrophils, polymorphonuclear neutrophils, neutrophilic leukocyte, polymorphs, cells pmn, Neutrophil (cell), Polymorphonuclear cells/leukocytes, Polymorphonuclear cells, polymorphonuclear leukocyte, PMN, PMN cell, Polymorphonuclear leucocyte, Polymorphonuclear leukocyte (cell), Polymorphonuclear leukocyte, Neutrophil (body structure), Polymorphonuclear Cell, Polymorphonuclear Neutrophils, neutrophil, Polymorph, 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), 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
Latvian Polimorfonukleārie leikocīti, Neitrofili, Leikocīti, polimorfonukleārie
Polish Neutrofile, Granulocyty obojętnochłonne, Komórki LE, Leukocyty wielojądrzaste
Hungarian Neutrofilek, Neutrofil vérszint
Norwegian Leukocytter, nøytrofile, Nøytrofile leukocytter, Nøytrofile celler

Ontology: Neutrophilia (finding) (C0151683)

Definition (NCI) Abnormally high level of neutrophils in the blood.(NICHD)
Concepts Laboratory or Test Result (T034)
SnomedCT 165518003
Italian Conta dei neutrofili aumentata, Neutrofili aumentati, Conta dei neutrofili elevata
Dutch neutrofielen verhoogd, neutrofielentelling hoog, neutrofielentelling verhoogd
French Numération des neutrophiles élevée, Neutrophiles augmentés
German Neutrophile erhoeht, Neutrophilenzahl hoch, Neutrophilenzahl erhoeht
Portuguese Neutrófilos aumentados, Número de neutrófilos alto, Número de neutrófilos aumentado
Spanish Neutrófilos elevados, Recuento alto de neutrófilos, leucocitosis neutrofílica, neutrofilia (hallazgo), neutrofilia, Recuento elevado de neutrófilos
Japanese 好中球数増加, 好中球増加, コウチュウキュウスウゾウカ, コウチュウキュウゾウカ, コウチュウキュウスウコウチ, 好中球数高値
Czech Počet neutrofilů zvýšený, Vzestup neutrofilů, Vysoký počet neutrofilů
English Neutrophil count high, Neutrophil count increased, increased neutrophil count, increased neutrophil, count high neutrophils, counts high neutrophil, elevated neutrophil, high neutrophil count, increased neutrophils, neutrophil elevated, count high neutrophil, elevated neutrophils, Neutrophils increased, Neutrophil count above reference range, Neutrophilia (finding), Neutrophilic leukocytosis, Neutrophilia, Neutrophilic leucocytosis
Hungarian Neutrofilek emelkedett, Neutrofil szám emelkedett, Neutrofil szám magas

Ontology: Neutrophil count (procedure) (C0200633)

Definition (NCI) A test to determine the number of neutrophils in a sample of blood.
Concepts Laboratory Procedure (T059)
SnomedCT 142931003, 165515000, 165520000, 142926000, 30630007
English Neutrophil count NOS, Neutrophil Count, seg (blood count), poly count, blood neutrophil count (lab test), blood neutrophil count, Neutrophil count (procedure), count polys, counts neutrophil, count neutrophils, neutrophil count, blood count segs, count neutrophil, counts neutrophils, Neutrophil count NOS (procedure), Neutrophil count, Neutrophil count [dup] (procedure)
Italian Conta dei neutrofili
Japanese 好中球数, コウチュウキュウスウ
Czech Počet neutrofilů
Hungarian Neutrofil szám
Spanish Neutrophil count NOS, recuento de neutrófilos, SAI (procedimiento), recuento de neutrófilos, SAI, recuento de neutrófilos (procedimiento), recuento de neutrófilos, Recuento de neutrófilos
Portuguese Número de neutrófilos
Dutch neutrofielentelling
French Neutrophiles
German Neutrophilenzahl

Ontology: Left shifted white blood cells (C0240173)

Concepts Finding (T033)
SnomedCT 87361006
LNC LP19259-8, MTHU007796
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
English Left shift leukocytic maturation alteration, 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, Leukocytes.left shift, Left shift, Left shift of WBC, Left shifted white blood cells, Left shifted white blood cells (finding)
Czech Posun doleva (hematologický), Posun doleva
Hungarian Balra tolódás (hematológiai), Balra tolódás