title: White blood cell left shift in a neonate: a case of mistaken identity.
abstract: We present a full-term male infant who presented with tachypnea and an increased band count on his complete blood count (CBC) with an immature to total neutrophil (I:T) ratio of 0.6 raising suspicion of early onset sepsis. A blood culture was drawn and he was started on appropriate antibiotics. The patient's clinical condition rapidly improved; however, the white cell count 'left shift' persisted. When a detailed family history was obtained, it was discovered that the father, paternal uncle and the grandfather had been diagnosed with Pelger-Huet anomaly (PHA). As the urine, blood and CSF cultures were all negative in this now well-appearing infant, the left shift on the CBC was believed to be due to inheritance of the PHA. We present this case to emphasize that even in this age of sophisticated laboratory evaluation, a good clinical history, including family history, and clinical evaluation, are essential for accurate diagnosis.
authors.affiliation: Department of Pediatrics, Division of Neonatology, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Women and Children's Hospital of Buffalo, Buffalo NY 14222, USA.
authors.forename: I S I
authors.initials: IS
authors.lastname: Mohamed
authors.forename: R J
authors.initials: RJ
authors.lastname: Wynn
authors.forename: K
authors.initials: K
authors.lastname: Cominsky
authors.forename: A M
authors.initials: AM
authors.lastname: Reynolds
authors.forename: R M
authors.initials: RM
authors.lastname: Ryan
authors.forename: V H
authors.initials: VH
authors.lastname: Kumar
authors.forename: S
authors.initials: S
authors.lastname: Lakshminrusimha
mesh_terms: D003951:Diagnostic Errors; D006801:Humans; D007231:Infant, Newborn; D007958:Leukocyte Count; D008297:Male; D009504:Neutrophils / Q000473:pathology* / Q000648:ultrastructure; D010381:Pelger-Huet Anomaly / Q000097:blood / Q000175:diagnosis* / Q000235:genetics; D018805:Sepsis / Q000175:diagnosis*