Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Wednesday, February 09, 2005
    "What's a Smudge Cell?"

    ...asked V. on the phone.

    "I used to know that. Who's got smudge cells?" I answered.

    V. had drawn routine preop labs on a patient and the phone report came back showing a high white blood cell count and multiple smudge cells. I pondered further and came up with, "A smudge cell is... a cell that has been smudged," and started giggling. (Today's been a long day.)

    "Oh, thanks a lot."

    "Let me Google it and see what I can find." I found a site and started reading out loud:

    Patients often see a reference to smudge cells in their complete blood count (CBC) reports. Smudge cells are cells that are probably damaged during the CBC process. The cell walls rupture, and when seen under the microscope, they look like a smudge; hence the term smudge cells.

    Smudge cells are not unique to CLL. However, they are seen much more frequently and in much higher numbers in CLL than in any other condition. In patients with acute leukemias, there may be as many as 1 to 3 percent, but in CLL patients, smudge cells can be up to 20 percent of all cells, or higher.

    Halfway through the second paragraph I realized that I had clicked to a site giving information about chronic lymphocytic leukemia - CLL. V. suddenly said, "Oh. His white count's 35." (High.)

    "What's his differential?"

    "I don't know, I'll have to get the full report and call you back."

    Fiteen minutes later I found a message on my voicemail: "CLL, I'm sure of it. Shoot."



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