A sepsis screen is performed on a term neonate with poor feeding. Total leukocyte count is 9,000/mm3 with 30% total neutrophils and 8% band forms. Which value BEST supports a diagnosis of bacterial sepsis on the hematological profile?
- A Band count less than 1,000/mm3
- B Absolute neutrophil count greater than 7,000/mm3
- C Immature to total neutrophil ratio greater than 0.2 ✓
- D Total leukocyte count between 5,000 and 10,000/mm3
Correct answer: C. Immature to total neutrophil ratio greater than 0.2
Explanation
The immature to total (I:T) neutrophil ratio above 0.2 is an abnormal value in the hematological component of the neonatal sepsis screen and reflects a left shift. Here the I:T ratio is 8 divided by 38, about 0.21, which is abnormal. C normal absolute neutrophil count does not exclude sepsis, and a total count of 5,000 to 10,000/mm3 is within the normal range for a term neonate, so options B, A and D do not support sepsis.
Reference: Nelson Textbook of Pediatrics, 21st ed.
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