Smudge cells – include or exclude?
Increased focus is placed on the importance of smudge cells in connection with certain types of diagnoses.
A number of articles explore this subject and according to the article Percentage of Smudge Cells on Routine Blood Smear Predicts Survival in Chronic Lymphocytic Leukemia the writers suggest that the number of smudge cells may have important biologic correlations rather than being only an artifact of slide preparation.
Smudge Cells or Basket Cell-A Diagnostic Pitfall reviews that the smudge cells on the film will not be included in manual differential, thereby resulting in an undercounting of the actual lymphocytes present. So education is needed.
This is an interesting discussion and we would like to find out how your policies and routines look like when it comes to smudge cells.
Do you include the smudge cell in the differential? If yes when and why?