A blood film from a patient is reported as showing a left shift and toxic changes.
a) What is the likely diagnosis?
b) What is meant by a left shift?
c) What constitutes ‘toxic changes’?
"Left shift and toxic changes" is some anachronistic terminology still used to describe the morphological changes which occur in neutrophils in response to a variety of (usually infectious) stressors.
Causes of this picture:
Left shift is an increased proportion of immature granulocytes, predominantly neutrophils.
"Toxic changes" are morphological changes seen in neutrophils, which occur as a part of widespread neutrophil activation (usually in response to systemic infection). To call "toxic changes" on a blood film, the laboratory scientist needs to find at least two out of three of the following morphological changes:
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