CLL Smudge Cells

[SMILLER]

When numerous smudge cells are seen on a slide: In order to do an accurate manual diff does anyone routinely make another slide for the diff by adding albumin to the specimen in order to eliminate smudging?

I just came across this technique in a article, but we have never done this. When we add the comment "smudge cells present" to the manual diff, I guess we assume that if there is any significant variance between the automated and manual count due to smudge cells, that the doc will understand that the smudge cells would account for it.

[Steven Jeff]

The short answer is no. Unless the procedure adds something extra to the diagnosis, is there any value in doing it?

Steve

:)

[SMILLER]

Thanks Steve: No, I tend to agree with you.

In fact, as far as I know we've never had a doc call us and question why the manual diff doesn't exactly match the auto diff. In fact, since we only report an absolute diff from the analyzers, I doubt this will ever happen!

[daviem]

i am unsure of your meaning, when you do a manual diff you still use the total wcc as the absolute, then a manual count of cells gives you a manual percentage of the cells which when applied to the total count will give you a manual absolute differential. i know technology has advanced but i would still rely on a manual differential on all counts especially when early or possibly early cells are involved.

[Steven Jeff]

i would still rely on a manual differential on all counts especially when early or possibly early cells are involved.

I would agree with you daviem with the more complicated morphology of AML, APML, CML etc. But smudge('smear cells' in the UK) cells are classically seen in CLL and I don't think it matters what the relative number of smudge cells are present, it doesn't change the diagnosis from CLL. If the analyser reports lymphocyte count of 30, we may review a blood film and just report CLL blood picture (if already diagnosed) without actually doing a manual WBC differential.

Steve

:)

[SMILLER]

I guess another thing here is that a CLL may at some point progress to a ALL or lymphoma, so we want to scope the lymphs just to make sure there are no clefted or pro forms.

We do manual diffs for leukemias, lymphomas, MMs, etc. once per patient stay anyway, but we never bother about the smudge cells other than report them as a morphology comment.

In the article i was referring to, they wanted to see if thier manual count (done with the albumin treatment) correlated with the analyzer diff--which it did. The idea being that they did not have to do the relatively laborous manual diff for uncomplicated CLL CBCs.

[kjmt]

I'm new here-- hi everyone

I have used albumin, on occasion, to preserve cells when doing a manual diff if I believe it will make a huge difference in the counts. I have found it helps when the white count is very high (~100,000) and a lot of the early cells become distorted when making the slide...more in AML/ALL, not for a simple CLL. Do I think it makes any difference in the diagnosis? Probably not! But it makes me feel better. I work in a hospital where this might be useful once a month, so it's not a big deal. It is not required, and our procedure solely suggests using this technique at the technologist's discretion.

[Steven Jeff]

I have used albumin, on occasion, to preserve cells when doing a manual diff.

Welcome kjmt, I am sure like the rest of us that you will find this a great site.

I had not appreciated the concept that using albumin preserves the cells for manual differentials. This is far more useful for other haematology disorders than CLL. Do either you or SMILER have a reference for this technique?

Many thanks

Steve Jeff

:)