Smudge Cells in Chronic Lymphocytic Leukemia: Pathophysiology, Laboratory Considerations, and Clinical Significance
Smudge Cells in Chronic Lymphocytic Leukemia: Pathophysiology, Laboratory Considerations, and Clinical Significance
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DOI：
10.1093/labmed/lmaa119
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发表时间：
2021-02-02
影响因子：
1.3
通讯作者：
Mehta, Shashi R.
中科院分区：
文献类型：
--
作者：
Marionneaux, Steven M.;Keohane, Elaine M.;Mehta, Shashi R.
慢性淋巴细胞白血病（CLL）是临床实验室最常见的白血病。CLL淋巴细胞中的细胞骨架缺陷可导致在血膜制备期间形成高达75%的污迹细胞（SC）。在白色血细胞（WBC）分类中未能考虑这些受损的淋巴细胞会降低结果的准确性和重现性。由于缺乏处理CLL中SC的明确操作标准，不同实验室可能会采用不同的方法来减少SC引起的错误。这篇综述探讨了SC的病理生理学，它们对CLL中WBC分化的影响，以及这些结果如何影响临床决策。各种SC校正方法的利弊描述，以帮助实验室制定一个优化的协议，以减少白细胞分类的错误和不一致。最后，讨论了潜在效用的SC计数作为慢性淋巴细胞白血病预后的指标在实验室与不同的技术。
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.