Clinical Laboratory and Medical Imaging Sciences, School of Health Professions, Rutgers University, Newark, New Jersey, USA.
Scientific Affairs, Cellavision AB, Lund, Sweden.
Lab Med. 2021 Sep 1;52(5):426-438. doi: 10.1093/labmed/lmaa119.
Chronic lymphocytic leukemia (CLL) is the most commonly encountered leukemia in the clinical laboratory. 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. Lacking clear practice standards on handling SCs in CLL, different laboratories may employ different methods to mitigate SC-induced errors. This review explores the pathophysiology of SCs, their effect on WBC differentials in CLL, and how these results can impact clinical decisions. The pros and cons of various SC corrective methods are described to assist laboratories in developing an optimized protocol to reduce errors and inconsistencies in WBC differentials. Finally, the potential utility of SC enumeration as an indicator of CLL prognosis is discussed in terms of laboratories with differing access to technology.
慢性淋巴细胞白血病（CLL）是临床实验室最常见的白血病。CLL 淋巴细胞的细胞骨架缺陷可导致在血涂片制备过程中形成多达 75%的涂抹细胞（SC）。如果在白细胞（WBC）分类中不考虑这些受损的淋巴细胞，会降低结果的准确性和重现性。由于 CLL 中没有关于处理 SC 的明确实践标准，不同的实验室可能采用不同的方法来减轻 SC 引起的误差。本综述探讨了 SC 的病理生理学、它们对 CLL 中 WBC 分类的影响，以及这些结果如何影响临床决策。描述了各种 SC 校正方法的优缺点，以帮助实验室制定优化的方案，减少 WBC 分类中的误差和不一致性。最后，根据实验室获得技术的不同，讨论了 SC 计数作为 CLL 预后指标的潜在效用。
