From the Guidelines
Right shift is a hematological finding that indicates the body is actively fighting an infection or inflammatory process, and the bone marrow is working overtime to produce neutrophils faster than they can fully mature, as seen in conditions such as bacterial infections, severe inflammation, or other high-demand conditions 1.
Definition and Causes
A right shift refers to an increase in the number of immature neutrophils (white blood cells) in the peripheral blood, which can be caused by various factors, including bacterial infections, severe inflammation, or other conditions that create high demand for neutrophils.
- The bone marrow releases immature neutrophils prematurely in response to infection or inflammation.
- A right shift is typically seen during bacterial infections, severe inflammation, or other conditions that create high demand for neutrophils.
Diagnosis and Investigation
When examining a complete blood count (CBC) with differential, increased bands, metamyelocytes, or myelocytes, which are precursors to mature neutrophils, can be noticed.
- This phenomenon is called a "right shift" because on traditional hematology reporting formats, these immature cells appear on the right side of the differential count.
- The presence of a right shift indicates that the body is actively fighting an infection or inflammatory process, and the bone marrow is working overtime to produce neutrophils faster than they can fully mature.
Clinical Implications
This finding should prompt further investigation into potential underlying infections or inflammatory conditions, especially if accompanied by leukocytosis (elevated white blood cell count) 1.
- The anemia may be surprisingly well tolerated in some patients, probably because of the increased red cell 2,3-DPG content, which is responsible for a rightward shift in the oxygen dissociation curve of hemoglobin 1.
- However, it is essential to identify and treat the underlying cause of the right shift to prevent complications and improve patient outcomes.
From the Research
Right Shift
- The term "right shift" is not directly mentioned in the provided studies, but it can be related to the concept of macrocytosis, which refers to an increase in the mean corpuscular volume (MCV) of red blood cells [(2,3)].
- Macrocytosis can be caused by various factors, including vitamin B12 and folate deficiencies, which can lead to megaloblastic anemia [(2,3,4)].
- A "right shift" in the context of a complete blood count (CBC) may refer to an increase in the number of mature red blood cells, which can be seen in conditions such as dehydration or polycythemia [no direct reference].
- However, without more specific information, it is difficult to determine the exact meaning of "right shift" in this context.
- Studies have shown that macrocytosis can be associated with various health problems, including anemia, cognitive impairment, and increased risk of certain diseases [(5,6)].
- It is essential to diagnose and treat the underlying cause of macrocytosis to prevent long-term complications [(2,3)].