White blood cell left shift in a neonate: A case of mistaken identity

I. S.I. Mohamed, R. J. Wynn, K. Cominsky, A. M. Reynolds, R. M. Ryan, V. H. Kumar, Satyanarayana Lakshminrusimha

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)378-380
Number of pages3
JournalJournal of Perinatology
Issue number6
StatePublished - Jun 1 2006
Externally publishedYes


  • Early onset sepsis
  • Family history
  • Full-term neonate
  • Pelger-Huet anomaly
  • WBC left shift

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology


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