Toxic granulation and vacuolization in neutrophilic myelocytes in peripheral blood smear (human)

Stain: May-Grnwald-Giemsa (MGG). The myelocyte (1) and the metamyelocyte (2) show toxic granulation, vacuolisation and cytoplasmic swelling. Toxic granulation is characterized by violet-purple granules of varying size in the cytoplasm; generally admixed with normal pink granules. The phenomenon occurs frequently at sepsis and other severe infections and toxic states as a result of denatured proteins in the cytoplasm i.e. rheumatoid arthritis or due to autophagocytosis within the cells. The cytoplasm is partly basophilic, cloudy and contains vacuoles with generally a coarse granulation.