Neutropenia is a serious hematopathologic change that should not be ignored. In almost all patients, it is an important primary or secondary indicator of significant underlying disease. While in some neutropenic patients the diagnostic work up will be simple, in others it is challenging. The value of examining a blood smear for toxic changes in neutrophils cannot be overemphasized; it may indicate the presence of systemic inflammation, as well as providing clues about prognosis and the extent of treatment the patient may require.