Hematopathology — Image #10 — Toxic Granulation   Toxic Changes
Toxic Changes  This band reflects all the "toxic changes" seen
in reactive neutrophils:    1. Left shift (it's a band)   2.
Toxic granulation: Coarse purple primary granules   3. Döhle
bodies: Blue pigment in the cytoplasm and clearly seen at the
cytoplasmic margin   4. Cytoplasmic vacuolization.  A
neutrophilic response to pyogenic bacteria can be seen within
hours. The primary granules contain lysozymes - hydrolytic
enzymes, defensins and peroxidase. Döhle bodies represent
disintegrating endoplasmic reticulum. Vacuoles show where
cytokines were released from storage vesicles. A very lacey or
moth-eaten neutrophilic cytoplasm is seen with overwhelming
infection. Occasionally the neutrophilic response is vigorous
enough to elevate significantly the WBC to 30,000/µL or more,
called a leukemoid reaction. A reactive left-shift includes
myelocytes and meta-myelocytes, a few promyelocytes, but should
not include blasts.