What are Smudge Cells?
What happens when the nucleus is crushed?
What are basket cells?
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Why smudge cells are formed in CLL?
Cytoskeletal defects in CLL lymphocytes can result in the formation of up to 75% smudge cells (SCs) during blood film preparation. Failure to account for these damaged lymphocytes in the white blood cell (WBC) differential diminishes the accuracy and reproducibility of the results.
What viruses cause smudge cells?
The smudge cells are well studied as a prognostic factor for chronic lymphocytic leukemia, but it is also found in viral infections. We experienced a case of abnormal hyperleukocytosis (WBC 41,600/mm3) associated with infectious mononucleosis (IM).
Are smear cells and smudge cells the same?
Smear or smudge cells (SCs) are broken CLL B cells present in blood smears of CLL patients. For almost a century, SCs were thought to be simply an artifact during the slide preparation.
What is smear cells?
A blood smear is a blood test that gives information about the number and shape of blood cells. It is often done as part of or along with a complete blood count (CBC). Sickle cell anemia is an inherited disorder in which abnormal hemoglobin (the red pigment inside red blood cells) is produced.
Do smudge cells always mean leukemia?
Smudge cells, also called basket cells, are most often associated with abnormally fragile lymphocytes in disorders such as chronic lymphocytic leukemia (CLL). However, they can also be seen in degenerating samples; in which case, their origin may not be lymphocytic.
Are smudge cells diagnostic?
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. Patients with >30% smudge cells show longer times before requiring treatment and longer survival rates than patients with fewer smudge cells.
Should I be concerned about smudge cells?
Background: It is reported that the percentage of smudge cells in the blood smear could be a prognostic indicator in chronic lymphocytic leukemia. However, the clinical significance of smudge cells in other hematological malignancies, solid tumors or non-malignant diseases is less clear.
What CD markers indicate leukemia?
CD38. CD38 is a diagnostic marker of chronic lymphoblastic leukemia (CLL) that plays a vital role in activating intracellular signaling pathways following the stimulation of malignant B-cells receptors.
Is CLL leukemia is fatal?
CLL is the most common form of leukemia found in adults in Western countries. Some patients die rapidly, within 2-3 years of diagnosis, due to complications from CLL, but most patients survive for 5-10 years.
How can you prevent cells from smudging?
This artifact can be avoided by adding a drop of serum albumin to four or five drops of blood before making the blood smear. Smudge cells are most commonly seen in disorders characterized by lymphocyte fragility, such as chronic lymphocytic leukemia and infectious mononucleosis.
What is a smear in microbiology?
A bacterial smear is a thin layer of bacteria placed on a slide for staining. Preparing the smear requires attention to a number of details that help prevent contamination of the culture and ensure safety to the preparer.
Which condition is indicated by smudge cells and small lymphocytes?
If you have CLL, the blood smear could show many abnormal looking lymphocytes called smudge cells.
Can Mono cause smudge cells?
We experienced a case of abnormal hyperleukocytosis (WBC 41,600/mm3) associated with infectious mononucleosis (IM). The smudge cells were observed in peripheral blood smears, and were counted by mistake for the normal lymphocytes by the automatic blood count meter.
Which condition is indicated by smudge cells and small lymphocytes?
If you have CLL, the blood smear could show many abnormal looking lymphocytes called smudge cells.
What is lymphocytosis with smudge cells?
Smudge cells are also observed; smudge cells are the artifacts produced by the lymphocytes damaged during the slide preparation. Large atypical cells, cleaved cells, and prolymphocytes are also often seen on the peripheral smear and may account for up to 55% of peripheral lymphocytes.
How can you prevent cells from smudging?
This artifact can be avoided by adding a drop of serum albumin to four or five drops of blood before making the blood smear. Smudge cells are most commonly seen in disorders characterized by lymphocyte fragility, such as chronic lymphocytic leukemia and infectious mononucleosis.
What do smudge cells mean? - JustAnswer
I'd like to add that smudge cells are more often due to a reactive process (to infection, for example) and are an artifact of the process where cells are prepared for a slide to look at under the microscope.
Clinical Significance of Smudge Cells in Peripheral Blood ... - PubMed
Our survey indicated that in all cancers, those who had higher percentage of smudge cells were prone to have poor outcomes when compared with the subjects with lower percentage of smudge cells. This finding was quite different from the results of previous studies in which the race-ethnicity of most …
Smudge Cells: Artifacts or Clinically Significant? – Lablogatory
In today’s hematology lab, when physicians order a CBC with differential, they typically request a CBC with automated differential. Thus, up to 85% of our CBCs are autovalidated because they are entirely within normal range, with no instrument flags. This leaves the technologist time to spend on those slides that do need a manual review.…
Smudge cells due to infectious mononucleosis - PubMed
The smudge cells are well studied as a prognostic factor for chronic lymphocytic leukemia, but it is also found in viral infections. We experienced a case of abnormal hyperleukocytosis (WBC 41,600/mm3) associated with infectious mononucleosis (IM). The smudge cells were observed in peripheral blood …
How are smudge cells formed?
Well, smudge cells are formed through a complex process. The normal formation of CLL is when the nucleus occupies the entire cell thus leaving a thin cytoplasmic rim behind. However, Lymphocytes of CLL are exposed to external pressure, which then takes time to flatten out, crushing them during the film preparation.
What Causes Smudge Cells?
Before we talk about the causes of Smudge Cell formation, we have to discuss Chronic Lymphocytic Leukemia (CLL) first. This type of cancer occurs when too many lymphocytes are produced by the bone marrow.
What happens if the Smudge Cells along with the absolute lymphocytes continue to rise?
If the Smudge Cells along with the absolute lymphocytes continue to rise, then the odds of a lymphoproliferative disorder such as CCL would be present. (6)
What side of the cell is the smudge cell?
The image above presents the clear appearance of Smudge Cells on the left side, which are the clumped up cells that are Violet in color. (3)
Is a smudge cell a lymphocyte?
In most cases, Smudge Cells are also classified as Lymphocytes, therefore including them in the absolute and relative differential counts. However, Smudge cells are not only found on those ab normal lymphocytes that are fragil e but also on some lymphocytes that are deteriorating. (1,2)
What is a smudge cell?
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.
What do we do when we have a cell we cannot identify?
But, what do we do when we have a cell we cannot identify? When we perform a manual differential under the microscope, technologists will joke or tell stories about the legendary “skipocyte”; that cell which, while it does not look malignant or clinically significant, we still can’t decide what it is, so it’s skipped. 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. However, despite the fact that we are taught that there is no such thing as a skipocyte, there are times when a tech will ignore the cell, hoping they don’t see another one. 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?
Can smudge cells be counted as lymphocytes?
Thus, guidelines have been suggested that the first choice for handling pesky smudge cells is to review the smear and report the automated diff with a morphology comment that smudge cells are present. If automated diffs are not available, smudge cells should be counted as lymphocytes, or in a separate category 4, as illustrated in Table 1. Study findings indicate that this method is sufficient for reporting a reliable manual differential on known CLL patients 3. By counting smudge cells separately, however, as discussed previously, these numbers can be used in newly diagnosed cases of CLL as a prognostic indicator.
Can smudge cells be counted?
It can be seen from these examples, that the method of counting differentials with smudge cells can alter the results reported to the physician. Any of the differential methods above that count smudge cells give essentially the same results. If smudge cells are not counted, the lymphs will be under reported and the neutrophils will be over represented compared to the auto diff. Excluding smudge cells from the manual differential count or merely reporting their presence without quantification will also yield unreliable results, and then necessitates performing an albumin differential.
Is a smudge cell a skipocyte?
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.
Do labs report smudge cells?
Some labs count these as their own category of cell and some labs merely report the presence of smudge cells. Other labs do not report smudge cells at all, with the exception being in known cases of CLL. In these CLL differentials, if the WBC count is very high, it may also be recommended to do a 200 cell differential.
Is a smudge cell a prognostic factor?
While smudge cells are not diagnostic of C LL, it has been shown that, in newly diagnosed CLL, a larger percentage of smudge cells is a better prognostic factor. Patients with >30% smudge cells show longer times before requiring treatment and longer survival rates than patients with fewer smudge cells.
What are Smudge Cells?
Normally, cells have well defined structures with an easily identifiable cytoplasmic membrane. However, there are these abnormal bunches of cells which are called as smudge cells that do not have this well-defined boundary. They are actually the remains of the dead lymphocytes that have combined together into groups. Hence, they are also known as Basket Cells.
What happens when the nucleus is crushed?
In normal cells, the nucleus occupies only a small portion of the cell while in case of CLL, it can occupy the entire cell. When an external pressure is applied, the thin cytoplasmic tends to get crushed as it is unable to take the pressure. This leads to the formation of smudge cells.
What are basket cells?
They are actually the remains of the dead lymphocytes that have combined together into groups. Hence, they are also known as Basket Cells. Smudge cells are often included into the classification of lymphocytes. Some people think that these cells are found only on the unhealthy lymphocytes but they can also occur on those lymphocytes that are weak.
