Which smear finding is commonly seen in chronic lymphocytic leukemia?

Which smear finding is commonly seen in chronic lymphocytic leukemia?

• A. Smudge cells
• B. Auer rods
• C. Burr cells
• D. Target cells

Answer: (A)

Fragile lymphocytes that rupture easily on smear preparation create smudge cells, a classic finding in chronic lymphocytic leukemia. In CLL, the small, mature-appearing lymphocytes are particularly fragile, so when a peripheral blood smear is made, many cells break apart, leaving those characteristic smear artifacts known as smudge cells (Gumprecht shadows). This helps explain why CLL often shows a high number of these smudge cells on the slide. In practice, this finding supports the diagnosis but is confirmed with flow cytometry showing a clonal B-cell population that typically expresses CD5 and CD23. The other findings don’t fit CLL: Auer rods are associated with acute myeloid leukemia, burr cells (echinocytes) appear with uremia or other conditions, and target cells are seen in liver disease or certain hemoglobinopathies.

Fragile lymphocytes that rupture easily on smear preparation create smudge cells, a classic finding in chronic lymphocytic leukemia. In CLL, the small, mature-appearing lymphocytes are particularly fragile, so when a peripheral blood smear is made, many cells break apart, leaving those characteristic smear artifacts known as smudge cells (Gumprecht shadows). This helps explain why CLL often shows a high number of these smudge cells on the slide. In practice, this finding supports the diagnosis but is confirmed with flow cytometry showing a clonal B-cell population that typically expresses CD5 and CD23.

The other findings don’t fit CLL: Auer rods are associated with acute myeloid leukemia, burr cells (echinocytes) appear with uremia or other conditions, and target cells are seen in liver disease or certain hemoglobinopathies.