Toxic vacuolation explained
| Toxic vacuolation |
| Synonym: | Toxic vacuolization |
| Causes: | Sepsis, bacterial infection, alcohol toxicity, liver failure, G-CSF treatment |
Toxic vacuolation, also known as toxic vacuolization,[1] is the formation of vacuoles in the cytoplasm of neutrophils in response to severe infections or inflammatory conditions.[2] [3]
Clinical significance
Toxic vacuolation is associated with sepsis, particularly when accompanied by toxic granulation.[4] The finding is also associated with bacterial infection, alcohol toxicity, liver failure, and treatment with granulocyte colony-stimulating factor, a cytokine drug used to increase the absolute neutrophil count in patients with neutropenia.[5] [6]
The formation of toxic vacuoles represents increased phagocytic activity, which is stimulated by the release of cytokines in response to inflammation or tissue injury. Toxic vacuolation frequently occurs in conjunction with toxic granulation and Döhle bodies in inflammatory states, and these findings are collectively referred to as toxic changes. Neutrophilia and left shift (the presence of immature neutrophil precursors such as band neutrophils and metamyelocytes in the peripheral blood) often accompany toxic changes, as these phenomena also occur in response to inflammation.
It has been suggested that neutrophil vacuoles not be labelled "toxic vacuoles" unless they are accompanied by other toxic changes, as vacuolation can occur in other conditions.[7]
Similar conditions
Vacuoles may form in neutrophils if a blood sample is left standing for several hours prior to blood smear preparation, but this is an artifactual change with no clinical significance. Artifactual vacuoles are small and of uniform size and distribution, in contrast to toxic vacuoles whose size and placement are variable. Individuals with neutral lipid storage disease may exhibit persistent lipid-filled vacuoles in neutrophils and other granulocytes, which is a distinct phenomenon termed Jordans' anomaly.[8]
See also
Notes and References
- Book: Betty Ciesla. Hematology in Practice. https://books.google.com/books?id=5td7DwAAQBAJ&pg=PA153. 27 November 2018. F.A. Davis. 978-0-8036-6825-6. 153. Chapter 10: Abnormalities of white blood cells: quantitative, qualitative and the lipid storage diseases.
- Book: Mary Louise Turgeon. Linne & Ringsrud's Clinical Laboratory Science - E-Book: The Basics and Routine Techniques. https://books.google.com/books?id=Y7fwAwAAQBAJ&pg=PA318. 6th. 14 April 2014. Elsevier Health Sciences. 978-0-323-29280-1. 318. Leukocytes and platelets.
- Book: Barbara J. Bain. Blood Cells: A Practical Guide. https://books.google.com/books?id=E_tpBQAAQBAJ&pg=PA112. 5. 11 November 2014. Wiley. 978-1-118-81729-2. 112–113. Chapter 3: Morphology of blood cells.
- Book: Barbara J. Bain. Imelda Bates. Mike A Laffan. Dacie and Lewis Practical Haematology. 11 August 2016. Elsevier Health Sciences. 978-0-7020-6925-3. 93. Chapter 5: Blood cell morphology in health and disease.
- Web site: Toxic change . eClinPath . Cornell University College of Veterinary Medicine . 2013 . 2019-06-28 .
- Web site: Neupogen, Granix, Zarxio, Nivestym (filgrastim, tbo-filgrastim, filgrastim-sndz, filgrastim-aafi, G-CSF) dosing, indications, interactions, adverse effects, and more. Medscape. Medscape Reference. 23 April 2019. 13 July 2019. https://web.archive.org/web/20190513214121/https://reference.medscape.com/drug/g-csf-neupogen-filgrastim-342164 . 13 May 2019 .
- Web site: Blood cell identification: Granulocytes and Monocytes: Neutrophil, toxic . Hematology and Clinical Microscopy Committee . Hematology and Clinical Microscopy Glossary . . 2019 . live . https://web.archive.org/web/20190628144822/https://documents.cap.org/documents/2019-hematology-clinical-microscopy-glossary.pdf . 2019-06-28 . 2019-06-28 .
- Book: John P. Greer. Sherrie L. Perkins. Wintrobe's Clinical Hematology. 12th. 1. December 2008. Lippincott Williams & Wilkins. Philadelphia, PA. 978-0-7817-6507-7. 1552. Chapter 62: Qualitative disorders of leukocytes.
