Toxic granulation

Toxic granulation refers to changes in granulocyte cells seen on examination of the peripheral blood film of patients with inflammatory conditions ¹. Toxic granulation are commonly found in patients with sepsis. Toxic granulation is the term used when the normally faint stippled granules in neutrophils stain an intense reddish violet, which is a consequence of activity against bacteria or proteins and is observed in serious infections, toxic or drug effects, or autoimmune processes (e.g., chronic polyarthritis) ². Along with Dohle bodies and cytosolic vacuolation, which are two other findings in the cytoplasm of granulocytes, toxic granulations are a peripheral blood film finding suggestive of an inflammatory process.

In clinical laboratories, toxic granulation could be simply reported as present or graded as either slight, moderate, or marked (i.e., 1+ through 4+) by laboratory professionals ³. Grading level depends on the degree of toxic granulation in individual cells and the relative fraction of neutrophils with toxic granulation ⁴. Irrespective of the hematology analyzer, ∼15% of the blood samples require manual microscopic observation either because of biological rules or analyzer flags ⁵, and toxic granulation report helps to arrive at a diagnosis in some cases during this process. However, the evaluation of toxic granulation is time‐consuming and subjective, which limits its application. Despite the significant improvements in automated blood film analysis systems in recent years, the automatic evaluation of toxic granulation anomaly has not been directly researched yet.

Toxic granulation causes

Toxic granulation are commonly found in patients with sepsis. Toxic granulation is the term used when the normally faint stippled granules in neutrophils stain an intense reddish violet, which is a consequence of activity against bacteria or proteins and is observed in serious infections, toxic or drug effects, or autoimmune processes (e.g., chronic polyarthritis) ². Along with Dohle bodies and cytosolic vacuolation, which are two other findings in the cytoplasm of granulocytes, toxic granulations are a peripheral blood film finding suggestive of an inflammatory process.

References

1. Granularity Index of the SYSMEX XE-5000 hematology analyzer as a replacement for manual microscopy of toxic granulation neutrophils in patients with inflammatory diseases. Clin Chem Lab Med. 2011 Jul;49(7):1193-8. doi: 10.1515/CCLM.2011.188. Epub 2011 May 17. https://doi.org/10.1515/CCLM.2011.188
2. Theml H,Diem H,Haferlach T. Color Atlas of Hematology—Practical Microscopic and Clinical Diagnosis. Stuttgart, New York: Thieme; 2004. 198 p.
3. Qiao, G. , Zong, G. , Wang, J. and Sun, M. (2011), Automatic toxic granulation detection and grading based on speeded up robust features. Cytometry, 79A: 887-890. doi:10.1002/cyto.a.21113
4. Gulati G. Bood Cell Morphology: Grading Guide. Chicago, Illinois: American Society for Clinical Pathology Press; 2009. 96 p.
5. Cornet E,Perol JP,Troussard X. Performance evaluation and relevance of the CellaVision (TM) DM96 system in routine analysis and in patients with malignant hematological diseases. Int J Lab Hematol 2008; 30: 536–542.