Required section · Section 1 of 6
A flagged differential needs a morphology decision
An EDTA specimen collected at 08:10 is made into a Wright-Giemsa smear at 08:35. The complete opening table combines CBC, analyzer flags, specimen age, and morphology so the review starts with linked observations.
The result begins with observable evidence, not a diagnosis. Toxic change can correlate with inflammation, tissue injury, pregnancy, or granulocyte colony-stimulating factor exposure, but it does not establish sepsis or prognosis. The peripheral smear reviewer documents morphology and supports communication; the appropriate clinician completes diagnosis and workup.
This case uses an adult reference interval supplied by the case source population. No universal numeric threshold defines toxic-change severity, a critical value, or a review cutoff. Release only the locally standardized morphology comment after correlating the film, CBC differential, flags, and specimen age.
| Domain | Observed evidence | Interpretive use |
|---|---|---|
| CBC | WBC 17.8 × 10^9/L; absolute neutrophil count 14.1 × 10^9/L | Neutrophilia |
| Analyzer flags | Neutrophilia and immature granulocytes | Triggers morphology correlation |
| Specimen age | EDTA collected 08:10; smear prepared 08:35 | Fresh preparation supports interpretable vacuolation context |
| Morphology | Coarse dark granules, occasional pale peripheral inclusions, small-to-moderate vacuoles | Describe features; do not diagnose infection |
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