Classify the next review and choose the action

Case A is a fresh smear with neutrophilia, bands and metamyelocytes, coarse granules in many neutrophils, occasional Döhle bodies, and no blasts. This is compatible with a reactive morphology pattern when the laboratory’s criteria are met. The action is not to diagnose sepsis, but to release the locally standardized comment after the required review.

Case B was held for many hours before smear preparation and shows diffuse vacuolation with degranulation. The same appearances cannot confidently establish in vivo activation because storage can cause both changes. The defensible action is to qualify the limitation and seek a fresh specimen if local policy requires it.

Case C has large dark granules in multiple leukocyte lineages, while Case D has Döhle-like inclusions with large platelets and variable thrombocytopenia. These distributions point toward inherited look-alikes rather than a simple reactive pattern and require the designated review route. Select the bounded laboratory action from the evidence and local criteria, not from the clinical story alone.