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Module HEME-20 · Version 1.0

Reactive Granulocyte Changes

Classify common reactive neutrophil changes with the CBC differential, specimen age, film quality, and local review policy.

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Who this module is for

Medical laboratory scientists and hematology learners who perform or review peripheral blood smear differentials.

Learning objectives

  • State the written criteria that distinguish toxic granulation, Döhle bodies, and vacuolation from stain and storage artifact.
  • Distinguish true reactive change from stain precipitate, storage artifact, and inherited look-alikes.
  • Use severity, distribution, and accompanying CBC findings to determine review needs.

How completion works

Mark every required section done and answer every knowledge check in those sections correctly. The final save completes the module automatically.

Sources

13 sources

  1. 1. Electronic Code of Federal Regulations. 42 CFR 493.1255. Standard: Calibration and calibration verification procedures. Federal regulation. Accessed 2026-08-16.

    Source note · federal regulation

  2. 2. Electronic Code of Federal Regulations. 42 CFR 493.1256. Standard: Control procedures. Federal regulation. Accessed 2026-08-16.

    Source note · federal regulation

  3. 3. Electronic Code of Federal Regulations. 42 CFR 493.1423. Standard: Testing personnel qualifications. Federal regulation. Accessed 2026-08-16.

    Source note · federal regulation

  4. 4. College of American Pathologists. Hematology, Coagulation, and Clinical Microscopy Checklist, HEM.34500 Morphology Assessment (Phase II) and HEM.34600 Criteria for Blood Film Review (Phase II). CAP Accreditation Program, 12.09.2025 edition.

    Source note · accreditation standard

  5. 5. College of American Pathologists. Hematology and Clinical Microscopy Glossary. Professional society guidance. 2026. Accessed 2026-08-16.

    Source note · professional society guidance

  6. 6. Clinical and Laboratory Standards Institute. H20. Reference Leukocyte Differential Count (Proportional) and Evaluation of Instrumental Methods. 3rd ed. April 2026. Consensus standard. Accessed 2026-08-16.

    Source note · consensus standard

  7. 7. Palmer L, Briggs C, McFadden S, et al. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. International Journal of Laboratory Hematology. 2015;37:287-303. Accessed 2026-08-16.

    Source note · consensus standard

  8. 8. Kataoka I, Cotran RS, Finlan M. Lysosomal and ultrastructural changes in human toxic neutrophils during bacterial infection. Journal of Experimental Medicine. 1969;129:267-293. Accessed 2026-08-16.

    Source note · peer-reviewed literature

  9. 9. Marionneaux S. Nonmalignant Leukocyte Disorders. Rodak's Hematology. 2020:445-465. Accessed 2026-08-16.

    Source note · peer-reviewed literature

  10. 10. Vives-Corrons JL, Briggs C, Simon-Lopez R, et al. Effect of EDTA-anticoagulated whole blood storage on cell morphology examination: a need for standardization. International Journal of Laboratory Hematology. 2014;36:222-226. Accessed 2026-08-16.

    Source note · peer-reviewed literature

  11. 11. Savoia A, Pecci A. MYH9-Related Disease. GeneReviews. University of Washington, Seattle. Accessed 2026-08-16.

    Source note · professional society guidance

  12. 12. Mayo Clinic Laboratories. CBC, Complete Blood Count with Differential, Blood, test 42120. Manufacturer laboratory catalog. Accessed 2026-08-16.

    Source note · laboratory reference

  13. 13. LatticeMLS local controlled-practice requirement for a validated, rights-cleared morphology atlas. Local controlled practice. Accessed 2026-08-16.

    Source note · laboratory reference