Does the band cell survive the 21st century?

The differentiation of white blood cells is a worldwide-accepted method to obtain medical information. The conventional microscopic differential, however, is a laborious and expensive test with a low statistical value. Especially for band cell identification there is a wide range of variance. In this report we describe the intervariability of band cell enumeration.

From a septic patient, an EDTA anti-coagulated blood sample was obtained and a smear was made and stained (May-Grünwald Giemsa). A PowerPoint presentation was made twice of 100 random cells and sent to 157 different hospital laboratories in the Netherlands for a leukocyte differential. In the first survey neutrophils were differentiated in segmented and band neutrophils whereas in the second survey no discrimination was made between segmented and band neutrophils.

The first survey was responded by 68% of the laboratories (756 individuals) and the second survey by 73% of the laboratories (637 individuals). The laboratory mean values of the segmented neutrophils were 42.9% (SD: 7.8, range 22-64%) and 69.9% (SD: 1.4, range 62-72%) for the first and second survey respectively. For the individual technicians the values of the segmented neutrophils were 43.9% (SD: 11.2, range 15-72%) and 70.0% (SD: 2.0, range 59-77%) for the first and second survey respectively.

Because of the enormous variation of band cell counting we recommend to cease quantitative reporting of band cells, especially since the results only have a clinical relevance in a limited number of pathological circumstances.