Peripheral blood smearshowing a leukemic promyelocyte, CLL lymphocyte, and a smudge cell
(Wright-Giemsa, X 1000).
WBC Toxic granulations 28 Dohle bodies 5 Vacuolations 38 Smudge cells
32 Clefted lymphocytes 10 Hairy projections 2 Auer rods 2 RBC Anisocytosis 54 Poikilocytosis 31 Microcytosis 7 Macrocytosis 2 Hypochromasia 3 Polychromasia 35 Echinocytes (burr cells) 19 Dacrocytes (teardrops) 16 Spherocytes 6 Target cells 2 Acanthocytes 1 Ovalocytes 28 Schistocytes 5 Stomatocytes 2 Howell-Jolly bodies 1 Basophilic stipplings 5 Platelet Clumped platelets 3 Platelet satellitosis 5 Large platelets 8 Giant platelets 8 Overall Cell Morphology Code Concordance, Overall Type % Concordance, % WBC Toxic granulations 78.
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.
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.
If a manual differential is required, however, an albumin-prepared smear is often necessary due to an abundance of smudge cells on the non-albumin slide (thereby hindering an accurate counting of the lymphocytes and prolymphocytes).
The grade is determined for hyposegmentation, by the percentage of neutrophils with bilobed and unilobed nuclei; for hypogranularity, by the number of hypogranular cells as a percentage of all granulocytes; for cytoplasmic fragments and hypogranular platelets, as a percentage of the sum of all platelets and cytoplasmic fragments; and for smudge cells
, based on smudge cells
as a percentage of all white blood cells.
Throughout this episode the patient had WBC counts of >300,000/L with significant smudge cells
showing on the differential smear.