Lymphocytosis with Smudge Cells Is Not Equivalent to Chronic Lymphocytic Leukemia

Abstract

Chronic lymphocytic leukemia (CLL) often presents with lymphocytosis and smudge cells (SCs) on routine peripheral blood (PB) tests. In some cases, these findings are assumed to be sufficient to diagnose CLL. We present a 54-year-old male who was referred for further management of progressing CLL. At the initial presentation, he looked unwell and had diffuse lymphadenopathy and splenomegaly. Blood work showed normocytic anemia (hemoglobin 72 g/L), thrombocytopenia (platelet count 74 × 10<sup>9</sup>/L), leukocytosis (white blood cell count 135.5 × 10<sup>9</sup>/L) including lymphocytosis (130.1 × 10<sup>9</sup>/L), and the presence of SCs on a PB smear. Additional workup including flow cytometry (FC), bone marrow biopsy, and lymph node biopsy led to a diagnosis of leukemic stage of advanced-stage mantle cell lymphoma. Although lymphocytosis with SCs is more frequently and in higher quantities seen in CLL they are not pathognomonic and can be present in a variety of lymphoproliferative disorders. Additional diagnostic examination of cell morphology and FC to assess clonality and determine the immunotype of lymphocytes are required to establish an accurate diagnosis and determine appropriate further management of the specific disease type.

Clinico-hematological profile of chronic lymphoproliferative disorders in patients presenting with lymphocytosis

“…Most commonly, CLL presents with lymphocytosis, but up to a third of other chronic LPDs can have high lymphocyte count as well. 9 The current study was planned to fill the gap by assessing the spectrum of chronic LPDs in patients presenting with lymphocytosis on bone marrow examination in a tertiary care setting.…”

“…Open Access J Pak Med Assoc Of the undetermined cases, strong suspicion of T-cell LPD (T-LPD) was found in 1(6.25%) case. The patient was a 76year-old male, with absolute lymphocyte count (ALC) of 98x10 9 /L, had B-symptoms, but no visceromegaly or lymphadenopathy.…”