Toxic vacuolation, also known as toxic vacuolization,
is the formation of
vacuoles in the
cytoplasm of
neutrophils
Neutrophils (also known as neutrocytes or heterophils) are the most abundant type of granulocytes and make up 40% to 70% of all white blood cells in humans. They form an essential part of the innate immune system, with their functions varying in ...
in response to severe
infections or
inflammatory conditions.
Clinical significance
Toxic vacuolation is associated with
sepsis, particularly when accompanied by
toxic granulation
Toxic granulation refers to dark coarse granules found in granulocytes, particularly neutrophils, in patients with inflammatory conditions.
Clinical significance
Along with Döhle bodies and toxic vacuolation, which are two other findings in the c ...
.
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 Absolute neutrophil count (ANC) is a measure of the number of neutrophil granulocytes (also known as polymorphonuclear cells, PMN's, polys, granulocytes, segmented neutrophils or segs) present in the blood. Neutrophils are a type of white blood ce ...
in patients with
neutropenia
Neutropenia is an abnormally low concentration of neutrophils (a type of white blood cell) in the blood. Neutrophils make up the majority of circulating white blood cells and serve as the primary defense against infections by destroying bacteria ...
.
The formation of toxic vacuoles represents increased
phagocytic activity, which is stimulated by the release of
cytokines
Cytokines are a broad and loose category of small proteins (~5–25 kDa) important in cell signaling. Cytokines are peptides and cannot cross the lipid bilayer of cells to enter the cytoplasm. Cytokines have been shown to be involved in autocrin ...
in response to inflammation or tissue injury. Toxic vacuolation frequently occurs in conjunction with
toxic granulation
Toxic granulation refers to dark coarse granules found in granulocytes, particularly neutrophils, in patients with inflammatory conditions.
Clinical significance
Along with Döhle bodies and toxic vacuolation, which are two other findings in the c ...
and
Döhle bodies in inflammatory states, and these findings are collectively referred to as ''toxic changes''.
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.
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.
See also
*
Leukemoid reaction
*
Acute phase reaction
References
{{Abnormal clinical and laboratory findings for blood
Histopathology
Hematology
Hematopathology
Abnormal clinical and laboratory findings for blood