HomeAnswersHematologysepticemiaWhat does high vacuolated neutrophils indicate?

Will vacuolated neutrophils suggest any problem other than sepsis?


The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

Dr. Vinodhini J.

Published At February 20, 2020
Reviewed AtSeptember 4, 2023

Patient's Query

Hello doctor,

I understand that a high vacuolated neutrophil result can be indicative of impending sepsis. Is it possible for someone to have this result and an infection that does not make the patient's symptoms visibly worse for a week? If so, could you give some examples of such infections? The patient is not on antibiotics. Can a high vacuolated neutrophil result indicate some sort of problem other than an infection?


Welcome to icliniq.com.

I appreciate your knowledge. You are right, vacuolated neutrophils suggest towards infective etiology is more likely. But let me know in such a case usually neutrophilia is also seen. So vacuolated neutrophils interpretation should be done in accordance with total WBC (white blood corpuscles) and total neutrophils count.

Your clinical correlation and physical examination are also necessary. Vacuolations in neutrophils suggest the phagocytic function of it in infection e.g. pneumonia, fungal infection, septicemia, typhoid, etc. Sometime in inflammation also such cells are seen.

As you have rapid weight loss cause for that should be searched. Some of the causes are HIV, acute infection, COPD, gastrointestinal problems like celiac disease and inflammatory bowel disease, hyperthyroidism, diabetes, tuberculosis, etc. So the clinical correlation is necessary to do further work up. Provide your other reports if it has been done along with a full CBC (complete blood count) report.

I hope this helps.

Patient's Query

Hi doctor,

Thank you for the reply,

The patient recently had pneumonia but apparently recovered. The WBC has remained elevated due to pneumonia and so has the CRP. At that time the high vacuolated neutrophil result came through. The WBC was 13.5 x10^9/L, CRP was 66.0 mg/L, and the neutrophils were 7.0 x10^9/L. Now, a week later, his WBC is 15.3, CRP is up to 148.5 mg/L, but his neutrophils, which have been up and down, are now 6.6 x10^9/L. The patient is definitely unwell but does not appear to be any sicker.


Welcome to icliniq.com.

So because of pneumonia infection weight loss is present. Neutrophilia and vacuolation in neutrophils are seen because of that. After one week, your total WBC count increases and your CRP is also high. In some patients, radiological and hematological recovery might take some time. But CRP remains elevated here. Hence, further workup needs to be done like sputum examination and sputum culture.

According to the culture report, further medication will be prescribed. If not improving, then suitable injectable medication and fluid resuscitation are given accordingly. During infections because of the release of some inflammatory mediator release appetite is also suppressed. Hence, weight loss occurs.

I hope this helps.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Goswami Parth Rajendragiri
Dr. Goswami Parth Rajendragiri


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