What are macrophages?

Macrophages are a type of white blood cell that plays a vital role in protecting the body from infection and in keeping tissues healthy. Their name comes from Greek words meaning “big eaters,” because they can surround, swallow, and digest harmful substances such as bacteria, viruses, and dead cells — a process called phagocytosis.

Macrophages start as monocytes, which are white blood cells that circulate in the bloodstream. When monocytes leave the blood and enter tissues throughout the body, they change (differentiate) into macrophages. Once in the tissue, they act as part of the immune system’s first line of defense.

What do macrophages do?

Macrophages have many important jobs in both the immune system and normal body maintenance:

• Phagocytosis (engulfing and digesting harmful material): Macrophages “eat” bacteria, viruses, dead cells, and debris. This helps clear infections and clean up damaged tissue after injury.

• Antigen presentation: After digesting a pathogen, macrophages display small pieces of it, called antigens, on their surface. These antigens signal other immune cells (especially T cells) to recognize and attack the invader.

• Cytokine production: Macrophages release chemical messengers called cytokines that help coordinate the immune response. Cytokines attract other white blood cells to areas of infection or inflammation and help control how strong or long the response lasts.

• Tissue repair and healing: Once the infection or injury is under control, macrophages help the body heal. They remove dead cells and release substances that promote tissue repair and reduce inflammation.

Through these combined roles, macrophages protect the body, remove waste, and help restore damaged tissues to normal.

Where are macrophages normally found?

Macrophages are found in almost every tissue in the body. Because their job is to detect infection and injury, they are located where they can easily sense changes in the environment.

Some macrophages have special names depending on where they are found:

• Kupffer cells  are found in the liver.

• Alveolar macrophages – in the lungs.

• Microglia are found in the brain and spinal cord.

• Langerhans cells are found in the skin.

• Histiocytes are found in connective tissue.

• Macrophages are also commonly found in the spleen, lymph nodes, and digestive tract.

Together, these cells form a network that helps the immune system monitor the entire body.

What do macrophages look like under the microscope?

Under the microscope, macrophages are large cells with a generous amount of cytoplasm (the body of the cell) and a single, often kidney-shaped nucleus. The cytoplasm can appear foamy or filled with small bubbles (vacuoles) when the macrophage has recently engulfed debris or microorganisms.

Macrophages can change their appearance and behavior depending on what is happening in the surrounding tissue. For example:

• Classically activated macrophages are stimulated by signals that trigger inflammation. They are more active in killing germs and infected cells.

• Alternatively activated macrophages respond to signals that promote healing. These cells help calm inflammation and repair tissue damage.

Pathologists can identify macrophages using special stains or immunohistochemistry (IHC) tests that highlight proteins commonly found in these cells, such as CD68 or CD163.

Why are macrophages important in disease?

Macrophages are involved in many diseases and conditions. They help fight infections, but they can also contribute to inflammation if they stay active too long. In cancer, macrophages may gather around tumors — sometimes helping the body fight the cancer, and sometimes promoting tumor growth by supporting blood vessel formation or reducing immune attack.

Because of their wide-ranging roles, macrophages are often mentioned in pathology reports describing inflammation, infection, or tumors. Their presence can help doctors understand the type of immune response occurring in a tissue.

Questions to ask your doctor

• What role do macrophages play in my pathology report?

• Does the presence of macrophages mean there is infection, inflammation, or something else?

• Are special tests used to identify macrophages in my sample?

• What do these findings mean for my diagnosis or treatment?