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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.