Question

A 20 year old college student presents to his primary care physician for a pre-employment physical examination. His physical exam is within normal limits. Blood samples for CBC with diff, PT/INR, PTT and CMP are collected and sent to Quest for testing. His results reveal: CBC with diff: WBC: 6.3 Band neutrophils: 65 RBC: 4.40 Segmented neutrophils: 5 Hgb: 14.0 Lymphocytes: 30 Hct: 42.1 Monocytes: 1 MCV: 95.6 Eosinophils: MCH: 31.8 Basophils: MCHC: 33.2 Metamyelocytes: 4 RDW: 12.9 Myelocytes: PLT: 250.9 Promyelocytes: PT/INR, PTT, and CMP are all within normal limits. Describe the peripheral blood findings. Based on all the data provided, what condition is most likely? What information is most diagnostic? Why is it important to recognize this benign condition?

Answer 1

Band neutrophil is derived from metamyelocytes, blood reference for band neutrophil is around 3 to 5% of WBC, in this case band neutrophil count is high.

Metamyeocytes are rarely seen in the peripheral blood, (these are immature cells found in bone marrow) it is seen in severe inflamation along with band neutrophil as part of left shift, a shift to the left in the diffrential WBC count could mean that significant number of neutrophil precursor such as myelocytes, promyelocytes,band neutrophil are present this could indicate inflamation, metabolic disoreder etc. This condition also could be due to Pelger-Huet Anomaly (PHA), PHA is considered to be benign disorder in most instance as individual with typical PHA are healthy,it is caused by mutation in LHR gene.

It is important to distinguish PHA from acquired or pseudo Pelger- Huet anomaly, as they may be found in individual with certain type of cancer of the type Leukemia

It is imporant