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. In such instances, these toxic granules may be unmasked in metamyelocytes, bands, and segmented neutrophils. 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 myelosuppressive therapy
- Uremia
Toxic VacuolizationVacuoles are clear, unstained areas in the cytoplasm of neutrophils. They may be a degenerative result of prolonged contact with EDTA anticoagulant. However, these vacuoles may be attributed to the abovementioned conditions when accompanied by toxic granulation and/or Döhle bodies. The arrows in the cell below indicate toxic vacuolization.
Döhle bodies
Döhle bodies are gray-blue oval inclusions that may be seen within the cytoplasm of segmented neutrophils, bands, and metamyelocytes in conditions that 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 the rough endoplasmic reticulum, which is left over from previous maturation stages and may be associated with toxic granulation and vacuolization. Döhle bodies are indicated by the arrows in the image below:
