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The standard definition of a left shift is an absolute band form count greater than 7700/microL. [3] There are competing explanations for the origin of the phrase "left shift," including the left-most button arrangement of early cell sorting machines [4] [5] and a 1920s publication by Josef Arneth, containing a graph in which immature neutrophils, with fewer segments, shifted the median left. [6]
A severe neutrophilia with left shift is referred to as a leukemoid reaction. The leukocyte alkaline phosphatase (LAP) score, which refers to the amount of alkaline phosphatase per neutrophil, will increase. In a severe infection, toxic granulation changes happen to the neutrophils. [citation needed] This can resemble Pelger-Huet anomaly. [6] [7]
An increase in the number of these immature neutrophils in circulation can be indicative of an infection for which they are being called to fight against, or some inflammatory process. The increase of band cells in the circulation is called bandemia and is a "left shift" process.
While many clinicians refer to the presence of neutrophilia as a "left shift", this is imprecise, as a left shift indicates the presence of immature neutrophil forms, [citation needed] but neutrophilia refers to the entire mass of neutrophils, both mature and immature. Neutrophilia can be indicative of:
A white blood cell differential is a medical laboratory test that provides information about the types and amounts of white blood cells in a person's blood. The test, which is usually ordered as part of a complete blood count (CBC), measures the amounts of the five normal white blood cell types – neutrophils, lymphocytes, monocytes, eosinophils and basophils – as well as abnormal cell ...
Just like a left shift, the presence of toxic neutrophils suggests increased granulocytopoiesis. However, in a freshly prepared blood smear, the presence of vacuolation in addition to toxic neutrophils reflects endotoxemia resulting in autolysis of neutrophils. This autodigestion is responsible for the cytoplasmic vacuolation.
Leukocytosis can be subcategorized by the type of white blood cell that is increased in number. Leukocytosis in which neutrophils are elevated is neutrophilia; leukocytosis in which lymphocyte count is elevated is lymphocytosis; leukocytosis in which monocyte count is elevated is monocytosis; and leukocytosis in which eosinophil count is elevated is eosinophilia.
Vacuoles may form in neutrophils if a blood sample is left standing for several hours prior to blood smear preparation, but this is an artifactual change with no clinical significance. [4] Artifactual vacuoles are small and of uniform size and distribution, in contrast to toxic vacuoles whose size and placement are variable. [1]