In reviewing the burned client’s laboratory report of white blood cell count with differential, all the following results are listed. Which laboratory finding indicates the possibility of sepsis?
A. The total white blood cell count is 9000/mm3.
B. The lymphocytes outnumber the basophils.
C. The “bands” outnumber the “segs.”
D. The monocyte count is 1,800/mm3.
Correct Answer: C. The “bands” outnumber the “segs.”
Normally, the mature segmented neutrophils (“segs”) are the major population of circulating leukocytes, constituting 55% to 70% of the total white blood count. Fewer than 3% to 5% of the circulating white blood cells should be the less mature “band” neutrophils. A left shift occurs when the bone marrow releases more immature neutrophils than mature neutrophils. Such a shift indicates severe infection or sepsis, in which the client’s immune system cannot keep pace with the infectious process.
Option A: The normal WBC count is 4,500 to 11,000/mm3. Burn injury causes systemic inflammatory response. The magnitude of the changes is roughly a function of burn size that is manifested by increased body temperature, increased WBC count, and increased metabolic rate, which makes diagnosis of infection in the burned patient more difficult.
Option B: Peripheral blood lymphocytes represent the most important line of host defense against pathogenic microorganisms in humans. Researchers found a reduction in the number of lymphocytes as well as WBC, which may contribute to the impairment of general mechanisms for immune regulation during burn shock and transition of blood to the level of self-regulation.
Option D: The normal monocyte count ranges from 100-700 per mm3 (2–8%). Severe burn and sepsis profoundly inhibit the functions of DC, monocyte, and macrophage. These phagocytes are the first cellular responders to severe burn injury after acute disruption of the skin barrier.
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