Color Atlas of Hematology - Practical Microscopic and Clinical ...

40Normal Cells of the Blood and Hematopoietic OrgansCell Degradation, Special Granulations, and NuclearAppendages in Neutrophilic Granulocytes and NuclearAnomaliesToxic granulation is the term used when the normally faint stippledgranules in segmented neutrophils stain an intense reddish violet, usuallyagainst a background of slightly basophilic cytoplasm; unlike the normalgranules, they stain particularly well in an acidic pH (5.4). This phenomenonis a consequence of activity against bacteria or proteins and is observedin serious infections, toxic or drug effects, or autoimmuneprocesses (e.g., chronic polyarthritis). At the same time, cytoplasmicvacuoles are often found, representing the end stage of phagocytosis (especiallyin cases of sepsis), as are Döhle bodies: small round bodies of basophiliccytoplasm that have been described particularly in scarlet fever,but may be present in all serious infections and toxic conditions. A deficiencyor complete absence of granulation in neutrophils is a sign ofsevere disturbance of the maturation process (e.g., in myelodysplasia oracute leukemia). The Pelger anomaly, named after its first describer, is ahereditary segmentation anomaly of granulocytes that results in round,rod-shaped, or bisegmented nuclei. The same appearance as a nonhereditarycondition (pseudo-Pelger formation, also called Pel–Ebstein fever, or[cyclic] Murchison syndrome) indicates a severe infectious or toxic stressresponse or incipient myelodysplasia; it also may accompany manifestleukemia.