Morphology: toxic change refers to abnormalities in the cytoplasm of neutrophils including vacuolation (clear round areas that may coalesce to create a foamy appearance), Döhle bodies (dark blue irregular granules), and cytoplasmic basophilia (darker staining of cytoplasm). Toxic change can occur in mature (segmented) and immature (band) neutrophils.

Look alike: monocytes

Commonly seen with: bands (left shift)

Clinical relevance: toxic change indicates inflammation. Usually accompanied by left shift (increased number of bands). Inflammatory cytokines stimulate neutrophil production and release of both mature (segmented) and immature (band) neutrophils from the bone marrow.