Significance of green granules in neutrophils and monocytes

Intracytoplasmic green granules in neutrophils have been the subject of conjecture and discussion. Sometimes nicknamed "death cells," these granules are often associated with severe liver disease and have been said to predict acute bad outcomes in severely ill patients. Some recommend that the laboratory community report these granules to treating clinicians as an indication of poor prognosis. We report two patients presenting with secondary liver disease who were found to have blue-green neutrophilic inclusions on the peripheral blood smear. One patient died, while the other patient recovered. We propose that this morphologic finding is likely transient and is related to liver disease and that recovery is possible. Additionally, prognosis in intensive care units continues to be determined by a number of variables, such as age, comorbidities, and severity of illness.