From the Guidelines
Toxic granulation is a reactive change in neutrophils that indicates the body is fighting an infection, and its presence suggests an active inflammatory process, but it does not require specific treatment itself. The presence of toxic granulation in neutrophils is often associated with acute bacterial infections or inflammatory conditions, and it appears due to increased production of lysosomal enzymes and other antimicrobial substances as neutrophils respond to infection 1. When observed in a complete blood count (CBC) with differential, toxic granulation suggests an active inflammatory process, commonly bacterial infections like pneumonia, sepsis, or severe tissue injury. Some key points to consider when managing patients with toxic granulation include:
- No specific treatment is needed for toxic granulation itself; instead, the underlying infection or inflammation should be addressed with appropriate antibiotics or anti-inflammatory medications based on the specific diagnosis.
- The presence of toxic granulation often correlates with other laboratory findings such as increased white blood cell count (leukocytosis) and elevated C-reactive protein or erythrocyte sedimentation rate.
- As the infection resolves with proper treatment, toxic granulation will gradually disappear from the neutrophils, making it a useful marker for monitoring response to therapy. It is essential to note that the management of febrile neutropenia, which can be associated with toxic granulation, is critical, as the rate of major complications can be approximately 25% to 30% and mortality up to 11% 1. Therefore, the underlying infection or inflammation should be promptly addressed with appropriate antibiotics or anti-inflammatory medications to reduce the risk of complications and improve patient outcomes.
From the Research
Definition and Characteristics of Toxic Granulation
- Toxic granulation is a condition characterized by the presence of abnormal granules in blood neutrophils, which can be associated with infection or other diseases 2
- These granules are typically azurophilic and contain enzymes such as myeloperoxidase, beta-glucuronidase, and acid phosphatase 2
- The condition is also marked by an increase in acid mucosubstance in azurophilic granules, leading to intense Romanowsky dye staining of the toxic granulation neutrophil 2
Comparison with Overgranulation
- Overgranulation, also known as hypergranulation, is a condition where granulation tissue grows excessively beyond the wound surface, delaying wound healing 3, 4, 5, 6
- Unlike toxic granulation, overgranulation is typically associated with wound care and tissue viability, rather than blood neutrophils 3, 4, 5, 6
- Overgranulation can be caused by infection, occlusive dressings, friction, nutritional deficits, or stress, and can be managed through various treatment options, including non-traumatic methods of removal and wait-and-see approaches 3, 4, 5, 6
Key Differences and Similarities
- While toxic granulation and overgranulation are distinct conditions, they both involve abnormal granule formation and can be associated with infection or other diseases 2, 3, 4, 5, 6
- However, the context and characteristics of the two conditions differ significantly, with toxic granulation relating to blood neutrophils and overgranulation relating to wound care and tissue viability 2, 3, 4, 5, 6