The Labora-Story

Where are the Smudge Cells in this CLL???

By Cheyenne Reyes posted 22 days ago

  
Where are the Smudge Cells in this CLL???
Krystal Yu, MLS(ASCP)cm


Patient X is a 58-year-old Caucasian female who went to her primary care physician complaining of back and shoulder pain. Before this pain occurred, the patient was active and able to walk four miles a day, three days a week. 

CBC testing from this visit revealed leukocytosis, anemia with moderate polychromasia, mild anisopoikilocytosis,and 0-2 schistocytes per HPF, with marked thrombocytopenia. Differential showed lymphocytosis at 89% with approximately 60% of lymphs being slightly atypical. 



_________________________
Normal appearing lymphocytes

2 "Atypical" plasmacytoid appearing lymphocytes 


Previous medical history included: hepatic hemangioma, kidney stones, and an appendectomy. The patient was a 10 pack a year smoker, but quit in 2000. The patient drinks socially and has never used illicit drugs. Patient’s father has diabetes, and mother has a history of hypertension and GIST. 

Patient’s admitting vital signs are: blood pressure 123/63, pulse 107, temperature 36.8° C, respiratory rate 20, height 5’4, weight 144 lbs., O2 97%. 

A bone marrow aspirate was collected on patient X. Flow cytometry revealed the following:


Events

Total %

Visibility %

Events

100000

100.000

100.000

Viable Events

98223

98.223

100.000

Total Plasma Cells

62372

62.372

63.501

MM Plasma Cells

62372

62.372

63.501

Normal Plasma Cells

0

NA

NA


Primary Plasma Cell Leukemia (PCL) is an aggressive form of multiple myeloma characterized by high levels of abnormal plasma cells circulating in peripheral blood. PCL is differentiated from myeloma by the percentage of plasma cells circulating in the patient’s blood. To be diagnosed with PCL the patient should have >20% of their circulating leukocytes be plasma cells. Symptoms of PCL are very similar to that of myeloma. Patients can present with bone pain, fatigue, recurrent infections, bleeding, high levels of calcium, and large spleen and/or liver. To classify as an abnormal plasma cell the plasma cells found in the bone marrow must be positive for CD138, CD38, and CD27. These cells must also be negative for CD19, CD20, CD45, CD56, and CD81. All of patient X’s plasma cells were abnormal.

These “atypical” lymphocytes seen in patent X’s blood were in fact plasma cells. As a Medical Laboratory Scientist I played a crucial role in aiding the diagnosis and quick treatment of this patient. Sometimes we may forget how important our role is in patient care since most of us never see them and they never see us. This is a reminder that what we do is so important and medicine would not be possible with the scientists behind it!!


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