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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]
Leukocytosis is a condition in which the white cell count is above the normal range in the blood. [1] [2] It is frequently a sign of an inflammatory response, [3] most commonly the result of infection, but may also occur following certain parasitic infections or bone tumors as well as leukemia.
It thus overlaps with the concept of left shift—bandemia is a principal type of left shift and many (perhaps most) clinical mentions of the latter refer to instances of this type. [citation needed] It is a signifier of infection (or sepsis) or inflammation. [1] Measurement of it can play a role in the approach to appendicitis. [2]
An ANC less than 1500 cells/μL is defined as neutropenia and increases risk of infection. Neutropenia is the condition of a low ANC, and the most common condition where an ANC would be measured is in the setting of chemotherapy for cancer. [citation needed] Neutrophilia indicates an elevated count.
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Toxic vacuolation is associated with sepsis, particularly when accompanied by toxic granulation. [4] The finding is also associated with bacterial infection, [3] alcohol toxicity, liver failure, [4] and treatment with granulocyte colony-stimulating factor, a cytokine drug used to increase the absolute neutrophil count in patients with neutropenia.
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