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Along with Döhle bodies and toxic vacuolation, which are two other findings in the cytoplasm of granulocytes, toxic granulation is a peripheral blood film finding suggestive of an inflammatory process. [1] Toxic granulation is often found in patients with bacterial infection and sepsis, [1] [2] although the finding is nonspecific. [3]
Toxic vacuolation is associated with sepsis, particularly when accompanied by toxic granulation. [4] The finding is also associated with bacterial infection, [3] alcohol toxicity, liver failure, [4] and treatment with granulocyte colony-stimulating factor, a cytokine drug used to increase the absolute neutrophil count in patients with neutropenia.
If there are many neutrophils in the bloodstream containing Döhle bodies, these can be referred to as toxic neutrophils. Toxic neutrophils can also correspond to neutrophils that possess a more basophilic cytoplasm, basophilic granulation (infrequently observed), or cytoplasmic vacuoles in addition to one of the preceding cytoplasmic changes.
Qualitative abnormalities of white blood cells, like toxic granulation, are also visible on the blood smear. Modern complete blood count analyzers can provide an automated white blood cell differential, but they have a limited ability to differentiate immature and abnormal cells, so manual examination of the blood smear is frequently indicated.
Blood smear showing red blood cells with basophilic stippling. Basophilic stippling, also known as punctate basophilia, is the presence of numerous basophilic granules that are dispersed through the cytoplasm of erythrocytes in a peripheral blood smear.
These mediators are released by a process called degranulation following activation of the eosinophil, and are toxic to both parasite and host tissues. In normal individuals, eosinophils make up about 1–3% of white blood cells, and are about 12–17 micrometres in size with bilobed nuclei.
Conventionally, a leukocytosis exceeding 50,000 WBC/mm 3 with a significant increase in early neutrophil precursors is referred to as a leukemoid reaction. [2] The peripheral blood smear may show myelocytes, metamyelocytes, promyelocytes, and rarely myeloblasts; however, there is a mixture of early mature neutrophil precursors, in contrast to the immature forms typically seen in acute leukemia.
Neutrophils are the primary white blood cells that respond to a bacterial infection, so the most common cause of neutrophilia is a bacterial infection, especially pyogenic infections. [ 2 ] Neutrophils are also increased in any acute inflammation , so will be raised after a heart attack , [ 2 ] other infarct or burns .