Shift to the right

[s_le2006]

I'm sitting here doing my study guide for my next test. My instructor mentions that we should know what a shift to the right is. I've looked through my book and can't find anything. He mentioned it in lecture. From what I gather in my notes, monocytes and lymphocytes are high in with a right shift and this usually indicates a viral infection. I guess I was just wondering if this is correct. I just wanted to see if anyone could give me more info or add anything. Thanks in advance!

[pinkiepie_RN]

That's what I learned to be the definition of "shift to the right" when I took med-surg last semester. I think that's really all I was told to know and I don't even remember being tested on it. Hopefully someone else can shed some more light if necessary. Good luck!

[s_le2006]

I've got one more question, maybe you could answer dolcebellaluna....with a shift to the right is the WBC count low? In my notes I wrote that with a shift to the left WBC is high and with a shift to the right it's low. (The instructor was talking really fast and it's possible that I wrote it down wrong). Does that sound right to you?

[ElliShay]

A "left shift" is indicative of an increased number of banded (immature) neutrophils. A left shift can occur with either a HIGH or LOW white blood count. A left shift with a high WBC count indicates release of immature neutrophils in response to overwhelming inflammation or infection. A left shift with low WBC count indicates infection of such intensity that demand for neutrophils exceeds supply, or it can indicate recovery from bone marrow suppression. A right shift indicates that cells have more than the usual number of nuclear segments (liver disease, Down syndrome, some types of anemia).

Hope this helps!

[Daytonite, BSN, RN]

because a "shift to the left" is specific for polymorphonuclear leukocytes (neutrophils are the most common) which are produced in 7 to 14 days, only exist for 6 hours and whose primary purpose is phagocytosis during the inflammatory response, their continued elevated presence (the "shift to the left") on lab tests indicate an ongoing bacterial infection going on. when they shift back to the right one of two things has occurred: (1) the infection is clearing, or (2) the store of polymorphonuclear leukocytes is exhausted and the body cannot keep up with the supply that is required to fight off the infection.

[s_le2006]

ok..i'm getting a little confused. So you are saying if there is a shift to the right a bacterial infection is clearing or its gotten so bad that the body can't keep up with it. I have it written in my notes that a right shift could indicate a viral infection. I'm really confused...is this correct?

[Daytonite, BSN, RN]

i don't think your notes are wrong, it's just that i have never heard the terminology "shift to the right" used. you only have so many neutrophils. neutrophils are a short term, early response defense mechanism to an invader that has been detected. "shift to the left", however, is specifically used and refers to increased immature neutrophil production.

when there are viral infections such as mononucleosis, hepatitis or influenza there is neutropenia (decreased neutrophils) and your instructor is calling this a "shift to the right". this is because when the viruses of these types of disease enter the body they go directly into the cells and take over their metabolism. the virus remains hidden and is not immediately detected by the body's immune system. meanwhile the virus uses the cell metabolism to reproduce itself. the virus is well under way and multiplied by the time the body finally recognizes its presence. then, the body finally calls out the troops with the neutrophils being the first to respond. but it has a huge situation to fight. initially, there might be this "shift to the right" because there has been no response to the virus. then the troops (neutrophils) are called out in massive numbers system wide. as the body's store of neutrophils rapidly becomes depleted, the immature neutrophils get pulled into the war effort and you might see a short lived "shift to the left". they can't keep up for very long. as the neutrophils are depleted there will be a shift back to the right because there just are no more left in the cupboard. we're not talking about a little boo-boo on the arm; a virus is system-wide. make more sense now?

[s_le2006]

Yes, makes much more sense now! Thanks so much for you input! There was nothing in my book about the subject (except for a few paragraphs talking about a "shift to the left").

[Daytonite, BSN, RN]

It's all in understanding the underlying pathophysiology--the why. You're going to find that seeking the "why" of things makes a lot of light bulbs go off in your brain and that helps understand the rationale behind the decisions that will be taken. This is true for what the doctors are ordering as well as what we nurses are doing for patients.