Why smudge cells in cll

Chronic lymphocytic leukemia CLL is the most commonly encountered leukemia in the clinical laboratory. Failure to account for these damaged lymphocytes in the white blood cell WBC differential diminishes the accuracy and reproducibility of the results.

Lacking clear practice standards on handling SCs in CLL, different laboratories may employ different methods to mitigate SC-induced errors. The pros and cons of various SC corrective methods are described to assist laboratories in developing an optimized protocol to reduce errors and inconsistencies in WBC differentials.

Finally, the potential utility of SC enumeration as an indicator of CLL prognosis is discussed in terms of laboratories with differing access to technology. Most users should sign in with their email address. If you originally registered with a username please use that to sign in. To purchase short term access, please sign in to your Oxford Academic account above.

Don't already have an Oxford Academic account? Oxford University Press is a department of the University of Oxford. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide.

Sign In or Create an Account. Sign In. An agreement must be reached between the hematology laboratory and clinical services as to how semi-quantitative estimates will impact the need for further testing in view of patient care outcomes. Smudge Cells. This version of the course is no longer available. This leaves the technologist time to spend on those slides that do need a manual review. In reviewing a slide, we evaluate the WBCs, RBCs and platelets, and must pay attention to the counts as well as morphology.

But, what do we do when we have a cell we cannot identify? Perhaps the best way to deal with these cells would be to get consensus from other techs or the Hematology supervisor or to request a pathology review.

But, what do we do when we see smudge cells? Are they skipocytes? What exactly are they? Do we ignore these? Are they clinically significant? Do we count them as their own category of cells? Or something else? Firstly, what is a smudge cell? Smudge cells, or basket cells, are remnants of leukocytes. They have no cytoplasm, and sometimes all that can be seen are smashed nuclei. Smudge cells are formed from leukocytes, typically lymphocytes, that are fragile, and are destroyed or smudged in the physical process of making a smear.

But, what if the instrument makes the smear? In recent years, more labs are using automated analyzers that prepare and stain blood smears. Even though these have instrument settings based on the physical characteristics of each sample, we still tend to observe these traumatic injuries to leukocytes with automated slide making.

Whether we make slides manually or the instrument makes them, these fragile cells appear on the stained slide as ruptured cells called smudge cells. Smudge cells have also been called Gumprecht shadows, named after German scientists and researcher Ferdinand Adolph Gumprecht, who observed these on slides of patients with chronic lymphocytic leukemia CLL. We also see leukocytosis and smudge cells in viral conditions and chronic inflammatory diseases. However, the term Gumprecht shadows is reserved only for smudge cells in CLL cases.

Knowing what a smudge cell is, how do we handle them? Do we report the presence only? Do we count them? Or, do we ignore them entirely? Smudge cells are not skipocytes! For many years smudge cells were considered to be simply artifacts of slide making. More recently, studies have been conducted that show that there may be clinical significance to the number of smudge cells seen. While smudge cells are not diagnostic of CLL, it has been shown that, in newly diagnosed CLL, a larger percentage of smudge cells is a better prognostic factor.

These studies focused on vimentin, a protein that is important in lymphocyte cellular rigidity. Patients with low vimentin have more smudge cells and better survival rates.

If we are performing a slide review, we are reviewing these slides because of some sort of instrument flag or rule trigger. Corresponding author. This item has received. Under a Creative Commons license. Received 06 January Accepted 20 April Show more Show less. Table 1. Patient characteristics.. Objective We evaluated the relevance of using the smudge cell percentage in the blood smear as a prognostic marker in CLL.

Statistical analyses were executed using the GraphPad Prism 8. Results The mean age was 63 years 48 - 85 and the male: female sex ratio was 4. Easy and affordable, the percentage of SCs in a blood smear could be a reliable prognostic marker, accessible to all CLL patients, mainly those in developing countries.

Full Text. Peripheral blood smear examination Blood smears of our patients were prepared from EDTA-anticoagulated blood.

Figure 1. Patient characteristics. Figure 2. Figure 3. Rai, J. Chronic lymphocytic leukemia: Then and now. Am J Hematol, 91 , pp. Chronic lymphocytic leukemia: update on diagnosis, risk stratification and treatment. Am J Hematol, 94 , pp. Binet, A. Auquier, G. Dighiero, C. Chastang, H.

Piguet, J. Goasguen, et al. A new prognostic classification of chronic lymphocytic leukemia derived from a multivariate survival analysis. Cancer, 48 , pp. Rai, A. Sawitsky, E. Cronkite, A. Chanana, R. Levy, B. Clinical staging of chronic lymphocytic leukemia. Blood, 46 , pp. Baliakas, M. Mattsson, K. Stamatopoulos, R. Prognostic indices in chronic lymphocytic leukaemia: where do we stand how do we proceed?. J Intern Med, , pp. Brown, J. Hallam, E. Colucci-Guyon, S.

Rigidity of circulating lymphocytes is primarily conferred by vimentin intermediate filaments. J Immunol, , pp. Nowakowski, Y. Lee, N. Bone, W. Morice, D. Barnidge, D. Jelinek, et al. Proteomic analysis of chronic lymphocytic leukemia cells identifies vimentin as a novel prognostic factor for aggressive disease.

Blood, , pp. Nowakowski, D. James, T. Shanafelt, S. Geyer, B. Laplant, T. Call, et al. Using smudge cells on routine blood smears to predict clinical outcome in chronic lymphocytic leukemia: A universally available prognostic test. Mayo Clin Proc, 82 , pp.

Shanafelt, C. Zent, T. Call, N. Bone, et al.