A 6-year-old female presented with a two-day history of abdominal pain after being referred by her pediatrician for evaluation of "splenomegaly." The patient had been complaining of constipation for the past six days along with a few episodes of nausea and vomiting. On physical examination, a firm, non-tender mass was palpated extending at least 10 cm below the left costal margin.
Almost immediately, emergency physicians know what to do with most abnormal lab results. If a patient’s hemoglobin is 4.5 g/dL, they need a transfusion. If their troponin is 12.3 ng/ml, they are having cardiac infarction. If their lactic acid is 7.5 mmol/L, something terrible is going on. What if the only abnormality they have on their blood work is bandemia? Does it matter if their bands are 6%, 15%, or 32%? Or, are they all treated equally?