Just to settle a dispute-I am wondering what other hematologists' definition of a smudge cell would be. Some techs. in our lab contend that a smudge cell can be defined as any cell that has been disrupted................Others feel that the term 'smudge cell' refers specifically to those fragile lymphocytes such as those found in CLL that addition of albumin before making a slide can resolve. What is your opinion?

Smudge cells are usually lymphocytes but because the cytoplasm is not recognizable the cell origin can't be determined. It is a form of cell death. These cells are very fragile and can be easily damanaged by making a peripheral smear.

I agree with glenda248, they are fragile lymps. I was taught many years ago that smudge cells are often found in CLL and resolved with an abumin prep.

6 drops of whole blood with 1-2 drops albumin if my memory serves me correctly.

I would agree that while smudge cells are almost always the result of fragile lymphs, you cannot count them as such since you really do not know. Sometimes PMNs smudge also, they do look different from smudged lymphs.

Smudged lymphs are not unusual in CLL patients and sometimes young children. Some think that once smudge cells dissapear in a CLL smear, it means a worsening prognosis for the patient, as the tumor cells have become more robust.

Some think that once smudge cells dissapear in a CLL smear, it means a worsening prognosis for the patient, as the tumor cells have become more robust.

As someone who has not been anywhere near a Haematology Laboratory for over a decade (and who was pretty useless at it, even when I was in one) may I ask a really stupid question?

Could it not also mean that the patient is in remission?

I'm sorry if that is a very daft question, but, as I say, my Haematology knowledge is extremely weak (not as bad as my microbiology, chemical pathology, histology, etc - all of which is non-existant), but very, very weak nonetheless!!!!!!!!!!!!!

Edited April 26, 201114 yr by Malcolm Needs

There is a reference here: http://jco.ascopubs.org/content/27/11/1844.short, to an article about the number of smudge cells and a CLL cases's prognosis.

We had a pathologist a few years ago who would do this little "spot continuing ed" bits with whoever was in Hema when he wlked through. I believe this is when I first heard of this particular theory. Since then I have seen a few articles on it. If you google "smudge cells CLL" I am sure you will be able to find a couple.

The idea is that CLL is chronic because the tumor cells are fragile. Fragile enough to rupture on a push smear but not so fragile that most automated analyzers can count them accurately. Not sure why young children often have smudge cells. But for CLL patients this is good, because it means that their NK cells or spleen or whatever is able to get rid of the tumor cells before the load gets too heavy. When the lymphs become more robust, the leukemia becomes more acute, and the prognosis worsens.

Something like that, anyway.

Smudge cells can also be seen in cases of viral infestation of the periferal lymphocytes, for example Mononucleosis.

smudge cells at our place is nearly synonymous with CLL cells

We only report smudge cells if the dx or other clinical indicators point to CLL

dont be lazy dude, just google it http://www.random-matters.com/smudge-cells

My lab's policy is to count and report whatever is still intact. It is apparently not important to report the presence of smudge cells. I disagree with this...

So I deviated by using the albumin method to make a blood film, and I do a manual differential count from that. I will grade the number of smudge cells in the original slide and report it as a 1+, 2+, 3+ or 4+.

I would agree that while smudge cells are almost always the result of fragile lymphs, you cannot count them as such since you really do not know. Sometimes PMNs smudge also, they do look different from smudged lymphs.

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Aren't "smudged" PMN's known as Basket Cells? They have a very different, stringy, appearance.

Smear cells, basket cells, smudge cells, etc...

Where could we find the standard of the identity of these cells? =/

The synonym for a smudge cell is a basket cell. These so called "smudge cells/basket cells" are mechanically distorted, fragile white cells usually a lymphocyte. We grade our smudge cells as a percentage of all white cells. (<10 occasional, 10-25 1+, 25-50 2+, 50-75 3+, >75 4+) The origin of the cell is unknown since the cytoplasm is unrecognizable. They are not to be confused with a "damaged white cell" which is an artifactual change seen in blood smears from lipemic specimens.