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Infant chronically ill with rsv, pneumonia, ear infection, lab tests with high WBC, smudge cells, has sickle cell traits. Is it due to smudge cells?

Hi, my daughter is 9 months old and has been chronically I ll since she was about 5 months old. She had rsv, pneumonia 2x, and an ear infection that has had 3 med failures. She has had 2 lab results with high white count. 1st was 18.1 and last was 18.6. She also had smudge cells present, it did not say how many, just that she had them. Also 1st lab showed that some RN were too big and some were too small. 2nd showed normal rbc s. She has the sickle cell trait as well, not sure if this has anything to do with anything that is going on with her, but there is very little information about smudge cells inbpediatricnparients on the internet. My daughter has an appt. with hematology at U of M but until then, j would like to know more. Thank you.
Asked On : Fri, 13 Apr 2012
Answers:  2 Views:  2871
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Pediatrician, Infectious Diseases 's  Response
Hello,
Welcome to Healthcare Magic forum.
Smudge cells (or basket cells) are the remnant of a fragile cell that has been damaged in the process of making a blood smear. Most commonly, these cells are lymphoid(white blood cells or lymphocytes ) in nature. Precise lineage assignment cannot be done because the cell is not intact. Any intact cell in blood has two major parts the central nucleus and the surrounding cytoplasm.The “smudge” is actually the condensed nuclear material without identifiable cytoplasm. Smudge cells are most commonly seen in disorders characterized by lymphocyte fragility, such as chronic lymphocytic leukemia and infectious mononucleosis.However it can also be seen as artefact due to inappropriate technique of blood smear preparation.
In some laboratories the smudge cells are reported with a comment as “other” cells on the manual differential. In other laboratories the automated differential is reported with a qualitative comment that smudge cells are present, and in most laboratories an albumin smear is prepared and a manual differential is reported.
Whether to acknowledge the reported cells as artefact or abnormalities depend on the individual case assessment and can be best done by the treating hematologist after complete clinical evaluation.
In your child the increased white blood cells might most probably be due to the repeated infections, and the smudge cells might be due to the fragility of the cells,however its best to rule out an underlying immunocompromised condition by consulting your hematologist.


Hope that answers your query.
Wishing your child a speedy recovery and good health forever.
Regards

Answered: Fri, 13 Apr 2012
I find this answer helpful
Pediatrician, Infectious Diseases Dr. Hema Yadav's  Response
Hello,
Welcome to Healthcare Magic forum.
Smudge cells (or basket cells) are the remnant of a fragile cell that has been damaged in the process of making a blood smear. Most commonly, these cells are lymphoid(white blood cells or lymphocytes ) in nature. Precise lineage assignment cannot be done because the cell is not intact. Any intact cell in blood has two major parts the central nucleus and the surrounding cytoplasm.The “smudge” is actually the condensed nuclear material without identifiable cytoplasm. Smudge cells are most commonly seen in disorders characterized by lymphocyte fragility, such as chronic lymphocytic leukemia and infectious mononucleosis.However it can also be seen as artefact due to inappropriate technique of blood smear preparation.
In some laboratories the smudge cells are reported with a comment as “other” cells on the manual differential. In other laboratories the automated differential is reported with a qualitative comment that smudge cells are present, and in most laboratories an albumin smear is prepared and a manual differential is reported.
Whether to acknowledge the reported cells as artefact or abnormalities depend on the individual case assessment and can be best done by the treating hematologist after complete clinical evaluation.
In your child the increased white blood cells might most probably be due to the repeated infections, and the smudge cells might be due to the fragility of the cells,however its best to rule out an underlying immunocompromised condition by consulting your hematologist.


Hope that answers your query.
Wishing your child a speedy recovery and good health forever.
Regards

Answered: Fri, 13 Apr 2012
I find this answer helpful
Disclaimer: These answers are for your information only and not intended to replace your relationship with your treating physician.
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