High percentage of smudge cells in a patient with COVID19: Rediscovering their utility

Abstract

We present a patient with SARS‐CoV‐2 infection, with an unexpected presence of lymphocytosis. Examination of blood film revealed mature small lymphocytes associated with high percentage of smudge cells (63%). A peripheral flow cyometry evidenced a CD5 negative CLL. A high percentage of smudge cells is associated with CLL diagnosis and has an important prognostic value: better survival and prolonged time to first treatment. It is a useful index in developing countries with low access to molecular testing.

Longitudinal urinary biomarkers of immunological activation in covid-19 patients without clinically apparent kidney disease versus acute and chronic failure

“…Increased levels of MCP were reported before and linked to unfavorable outcomes secondary to the monocyte activation 2 , 64 . Similar fluctuation of the cytokines was reported before in blood samples obtained from COVID-19 3 , 5 , 35 , 63 – 65 . The universal presence of MUC-16 is somewhat puzzling, except that this marker has utility in guiding fluid replacement in heart failure 66 , 67 .…”

“…Our immunological profiling revealed that urine CCL23, CXCL13, IL-15, CD5, several members of the TNFαR family, and monocyte chemoattractant protein correlated with blood levels. Prior studies indicated that these molecules are an essential component of the immunological response in COVID-19 and other viral infections 3 , 5 , 7 , 8 , 28 , 56 , 60 , 63 . Though the dynamics of the investigated biomarkers seem to be less exaggerated as compared to blood levels, they were related to increased mortality, organ failure, and unfavorable outcome.…”

“…Their composition does not provide a coherent interpretation as CD5 is a scavenger receptor, decorin is matrix proteoglycan, IL-15 has a critical role in the viral response, and MMP12 has yet to establish a role in aneurysm TNSFRP12A 9 , 59 . However, in COVID-19, CD5 was seen as part of disease-specific presentation 63 . Kidney failure can be mediated via IL-15 and MMP12, which are often involved in monocyte response—a critical part of COVID-19 activation 2 , 64 .…”

Is a leukoerythroblastic blood picture common in COVID-19-positive adults?

“…al. that smudge cells are seen in COVID-19 patients [12]. These features are consistent with the findings of leukoerythroblastic reaction.…”

Emergence of Chronic Lymphocytic Leukemia During Admission for COVID-19: Cause or Coincidence?

“…Some of the data, however, are consistent with the mechanistic understanding proposed for this case. The median age for diagnosis of CLL is 72, and two of the cases, like the case presented herein, were unusually young at 49 and 55 years of age, consistent with (though far from diagnostic of) the concept of early unmasking due to an infectious trigger [ 7 , 9 ]. The case presented by Largeaud et al’s study was of an 83-year-old gentleman, but the authors provided evidence of a normal WBC count both one year before and at the time of admission, lymphocytosis with studies diagnostic of CLL on day 11 of admission, and subsequent resolution of lymphocytosis 5 months after discharge although the CLL clone was still detectable [ 10 ].…”