Bands cell count has been added to my CBC blood tests - Why?

[markjeep51]

Have CLL currently on w & w protocol. My last periodic blood test at the US Veterans Administration has apparently added another parameter to my CBC blood test. It is now measuring Bands cells count as part of CBC testing. My last blood test illustrated the following: Lymph 42%, Neut 49%, Mono 5%, Eosino 1% Baso 2 % and Bands 1%; all add up to 100% as expected. My WBC was 18,610/uL. I did a little research on the web and it appears that the usefulness of knowing ones Bands cell count is not very useful except in very specific cases like appendicitis. So my question is this; is there some recent research going on looking at a possible linkage between Bands Cell count and leukemia ? As I understand it and in very simple terms, Bands cells are basically immature neutrophil cells.

[AussieNeil Partner Administrator]

Having that additional information can be very useful when you have neutropenia. By splitting the neutrophil count into immature and mature neutrophil counts ("bands" or "left shift" for immature neutrophils and "segs" for mature neutrophils), it is possible to know when your bone marrow's capability to produce neutrophils is recovering, perhaps helped by G-CSF injections. (Neutrophils provide first line protection against bacterial infections).

Don't forget to look at your actual counts to understand your risk of infection. Your lymphocyte count is reassuringly low for someone with CLL and your neutrophil count is on the high side, though I note that in your concurrent post, you report a WBC of 17,310, vs 18,610 here?

Neil

[markjeep51 in reply to AussieNeil]

On Dec 6, I had a routine CBC which reported a WBC of 17.31, which is when the "atypical lymphocyte count" was first measured/reported. As a result of my oncologist not understanding why the "atypical lymphocyte count" was taken, he ordered another CBC on Dec 11 which recorded a WBC of 18.61 , did not report a "atypical count" again but did report a "Bands Count" for the first time. Thanks for responding so quickly. I am a little concerned why my neutrophil count is a bit high; I feel great but I did have a flu shot in either late October or early November, which may be the cause of my high neutrophil count.

[lankisterguy Volunteer in reply to markjeep51]

It seems like a strange answer- but check the name of the person that signed the 2 different pathology reports- one with atypical and one with bands.

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I bet they are different people. I have often seen these types of wording variations. Sometimes a new pathologist is over enthusiastic trying to show his knowledge. And other times it is just a style difference. And sometimes it is significant, but that should be a discussion between you and a CLL expert doctor or at least a well trained hematologist.

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I would be less worried about the words entered by the pathologist than I am about your hematologist that doesn't know how to interpret the test and did not take the time to contact the pathology lab to find out before he met with you.

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Len

[AussieNeil Partner Administrator in reply to lankisterguy]

Len, I concur with you regarding the pathologist nodes. They aren't consistent and may or may not highlight areas needing a closer look. Mark, that's why plotting your results and monitoring your trends is worth considering.

[markjeep51 in reply to lankisterguy]

I fully agree with your concern about my Veterans Administration hematologist not knowing how to fully interpret test results. I am aware of his limitations but since I get all my blood work and other tests done for free and he is willing to get me authorized many tests which normally would not be allowed, I am sticking with him. He is an extremely nice man. But that puts the burden on me to interpret the results or find someone to do the interpretation. The doctors at the Veterans Administration in general really want to satisfy the veteran and will fight with their management on what the veteran wants done. But with all this said, I fully intend to hire a private hematologist in parallel via Medicare to get a real professional opinion. In other words, most testing will be done at the VA and all interpretations done by a private doctor. I have used this approach multiple times over the years. One needs to really understand the limitations of the VA. I wanted to know if I needed to start tracking my Bands counts and Atypical counts and whether I needed to fully understand what these counts really mean relative to CLL. For the past 5 years, I have been tracking the critical blood parameters on an excel spread sheet; am an ex-engineer. It has however been difficult finding someone to clearly explain to me Flow Test & FISH results. I have discovered that the patient needs to have a basic understanding of what is going on and needs to pose their questions in an appropriate and clear fashion. Doctors do not have the time to give one a course in FISH test analysis but will typically respond to short discrete/specific questions.

[Tommy777 in reply to markjeep51]

Markjeep,

Was interested in your comments about the VA hematologist. I have been seeing Dr. Call of Mayo-Rochester for annual checkups in the summer along with full lab tests done by my primary during my annual physical. I have a primary care MD at the Hines VA in Chicago who prescribes all my medications and vitamins at no cost when I see her annually, and she is strongly recommending I see a VA hematologist. Up till now Dr. Call is my CLL specialist and don't see what I could gain from VA hematology, except more extensive CLL tests ( at no cost) than my primary can do. Welcome your feedback.

I include a tablespoon+ of matcha green tea in my morning fruit and vegetable smoothie, and stopped taking EGC tablets when my liver enzyme values went out of range. Have been taking matcha in tea or smoothies for many years prior to my CLL diagnosis in November, 2017, to improve and maintain my overall health. So far, so good.

[markjeep51 in reply to Tommy777]

I also went to the Mayo clinic in Minnesota for a second opinion back in 2013. I saw a Dr. Zent there who is now working in Rochester NY. He was one of the original doctors who did clinical I & II studies on green tea extract. I also take green tea tablets, curcumin and some other stuff and fortunately my liver is doing fine. My CLL/SLL seems to be pretty much stable at the moment but I can not prove that green tea or any other supplement had anything to do with stabilizing my CLL/SLL condition. My main complaint is that my IgG has continually decreased since on original diagnosis and will need to go on IgG infusions at some point in the future; not sure when though. As I previously implied, I don't mind going to the VA for tests (because they are free) but will continue to go outside the VA system for cancer consults / 2nd opinions. When it comes time for IgG infusions or some kind of chemo, I will need to perform a cost & medical benefit comparison analysis of what the VA will do for me versus getting treatment via Medicare or going totally private and paying cash for treatment. Good luck.

[SeymourB]

If you don't see bands listed, it's likely that your CBC was done automatically on a cell counting instrument - a "Coulter counter". Most automated instruments cannot reliably tell bands from segs.

If you do see bands, it's likely that your CBC was done manually with a microscope. That manual test may be called "CBC with Differentials" or just "Differentials", at least in the U.S.

When odd results come up on the Coulter counter, the instrument flags it on the printout. The technician is then supposed to re-run the test, call in a more senior person or pathologist to have a look, or if the tech is experienced, they may go ahead and do the manual differential themselves. It depends on the lab.

As your ALC and WBC ascend higher and higher above normal, the percentages listed on your test result for each cell type are less and less useful. They're really only useful if all your cell types are close to normal. So forget percentage figures on the test result - use only the absolute numbers.

All of these results should be taken with a grain or two of salt. There are acceptable error rates on the instrument when it's calibrated, such as +/-5% for new instruments, or +/-10% for ones 10 or so years old or more. I had blood drawn for 2 different doctors at the same sitting one time (they never talk to each other to coordinate this stuff), and the tubes were sent to the same lab. The results were slightly different - but within the acceptable variation limits.

Also, I found while reading comparative reviews of instruments, that cells like basophils and eosinophils are notoriously inaccurate when they are low - by as much as %40. I've seen mine come back as 0% - and my WBCs are only 30K ! Monocytes can be hard to count also.