Monday, January 6, 2020

CBC and Sepsis

PulmCrit (EMCrit)
PulmCrit - January 06, 2020 - By Josh Farkas
"Summary The Bullet:
  • No component of the complete blood cell count is a perfect indicator of septic shock. However, since this data is available to us, we should use it to maximal advantage.
  • White blood cell count is the least useful parameter. Persistent focus on the WBC isn’t evidence-based and should be curtailed.
  • Left-shift is often a delayed finding in septic shock. Measurements of left-shift (bandemia and immature granulocyte count) have substantial drawbacks. However, if a left-shift is found, this is a red flag which warrants further attention.
  • Neutrophil to lymphocyte ratio (NLR) might be the single most useful parameter. NLR responds rapidly to infection and is uniformly available across all laboratories. However, NLR is fundamentally an index of physiologic stress (not septic shock) – so clinical context and judgement are required to interpret this properly."