Toxic Changes

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The page below is a sample from the LabCE course White Cell and Platelet Disorders: Peripheral Blood Clues to Nonneoplastic Conditions. Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Toxic Changes

Toxic changes in neutrophils include:
  • Toxic granulation
  • Toxic vacuolization
  • Döhle bodies
Toxic granulation
In many infections or toxic stimulations, neutrophils respond with large dark blue intracytoplasmic azurophilic granules . These toxic granules may be unmasked in metamyelocytes, bands, and segmented neutrophils in such instances. Their presence indicates active phagocytosis with an increase in lysosomal activity. Toxic granulation is shown in the band neutrophil below.

Conditions associated with toxic granulation include:
  • Severe infectious processes or sepsis
  • Severe inflammatory states
  • Trauma
  • Burns
  • Certain cytokine medications
  • Pregnancy
  • Bone marrow response to myelosuppresive therapy
  • Uremia
Toxic Vacuolization
Vacuoles are clear, unstained areas in the cytoplasm of neutrophils. They may be a degenerative result of prolonged contact with EDTA anticoagulant. However, when accompanied by toxic granulation and/or Döhle bodies, these vacuoles may be attributed to any of the conditions stated above. Toxic vacuolization is indicated by the arrows in the cell below.

Döhle bodies
Döhle bodies are gray-blue oval inclusions that may be seen within the cytoplasm of segmented neutrophils, bands, and metamyelocytes in any of the conditions that also produce toxic granulation. If present, they are typically observed in the outer periphery of the cytoplasm, close to the cell membrane. Döhle bodies are composed of RNA from rough endoplasmic reticulum, which is left over from previous maturation stages and may be seen in association with toxic granulation and vacuolization. Döhle bodies are indicated by the arrows in the image below: