Peripheral blood smearshowing a leukemic promyelocyte, CLL lymphocyte, and a smudge cell
(Wright-Giemsa, X 1000).
Non-leucocyte classifications were also examined and the cells incorrectly identified as nucleated red cells, giant platelets, platelet aggregates, smudge cells or arte facts were reclassified.
This resulted from other cells (often smudge cells) being incorrectly classified as monocytes.
The disagreement is whether or not to report smudge cells. Some of us think that if the differential is performed using the slide prepared with albumin and smudge cells are not seen, that they should not be reported.
For CLL samples, the CBC report needs to include both the lymphocyte count and lymphocyte morphologic features, such as the presence of prolymphocytes, atypical lymphocytes, or smudge cells. The most accurate lymphocyte count is often provided by the automatic hematology analyzer (Coulter and others).
Section III provides guidelines for grading toxic granulation, toxic vacuolation, Dohle inclusion bodies, hypersegmentation, hyposegmentation, agranular/hypogranular granulocytes, cytoplasmic fragments/ agranular or hypogranular platelets, and smudge cells
. For each topic, clinical correlations associated with each morphologic finding are provided.
Throughout this episode the patient had WBC counts of >300,000/L with significant smudge cells
showing on the differential smear.