Help With Blood Smear/Rare Smudge Cells Noted

[Belladeg]

My son is 14 months old. He had low iron so the hematologist did some blood tests. I got the results and I, concerned with the words rare smudge cells noted. We go to our appt. on Wednesday so obviously they will discuss everything. Just wondering what your thoughts are. Here is the comment from the pathologist:
This peripheral smear for review reveals mild anisocytosis of the red blood cells, unremarkable PMN leukocytes, unremarkable lymphocytes, unremarkable monocytes, and unremarkable platelets. Blasts and schistocytes are not seen. Rare smudge cells are noted. The signs of sepsis are not seen. Dohle bodies, cytoplasmic vacuoles, and toxic granulations are all not seen within the cytoplasm of the PMN leukocytes. Platelet clumping is as well not seen. Review of the patient's indices reveals an unremarkable white blood cell count at 9.68 x10 to the 9th per liter, very mild anemia with a hematocrit of 31.9%, and an unremarkable platelet count of 343 x10 to the 9th per liter. DIAGNOSIS: PERIPHERAL SMEAR FOR REVIEW:1. MILD ANISOCYTOSIS OF THE RED BLOOD CELLS, UNREMARKABLE PMN LEUKOCYTES, UNREMARKABLE LYMPHOCYTES, UNREMARKABLE MONOCYTES, AND UNREMARKABLE PLATELETS ARE ALL SEEN.2. PLATELET CLUMPING IS NOT SEEN.3. BLASTS AND SCHISTOCYTES ARE ABSENT. 4. THE SIGNS OF SEPSIS ARE NOT SEEN. 5. PLEASE SEE ABOVE DISCUSSION.

[Ken_PA]

That's wonderful news :) Thanks for letting me know. As you can see, there is no cause for alarm or else the hema wouldn't be setting the next visit way out at 3 months.

Now you can take off some time from all the worry and analyzing. But in a week or so, look up how vitamin C is said to increase iron absorption. So I'd have your son take his iron when he has potatoes or orange juice or similar.

Congratulations on your good news.

[Belladeg]

Sounds good!  Thanks again!!!  =)

[Ken_PA]

His lymphocyte figures seem fine for his age, according to the chart at: https://www.childrensmn.org/references/lab/hematology/cbc-reference-value-table.pdf

The '%' is the percentage of lymphocytes out of all the white blood cells. The '#' is the actual counted number of lymphocytes.

Smudge cells happen because the cells are fragile and they get damaged and break open while preparing the slide of the blood smear test. There are other reasons besides leukemia why smudge cells can happen, so on Wednesday you will find out what the doc thinks is the actual non-leukemia cause. Maybe there are so few  smudge cells that the doc won't even care about that.

That leaves finding out the cause of the problem with the red blood cells, which doesn't seem serious anyway.

All the other blood cells are normal.

Good luck tomorrow. Let me know what you find out.

[Belladeg]

Thank you so much for your help!  Seeing the results sometimes can be scary when you don't fully understand what everything means, and it's easier said than done to wait sometimes.  And then Googling things, of course, was the worst thing I could have done!  I appreciate your help and I will definitely let you know what happens tomorrow, like you said, hopefully it will just be no worry and something else that caused it and not a big issue with his red blood cells.  Again, I appreciate your help!  And I'm new here, so I do apologize to anyone if I posted on the wrong board for my question.  

[Belladeg]

The doctor thinks it's either anemia or thalassemia.  Insurance wouldn't cover the tests for thalassemia unless it's medically necessary, so they are upping his iron intake for three months and then trying the test again.  If everything comes back normal, he said he is fine.  If the levels are still off, he said we will do further studies.  I asked about the smudge cells and he said it's normal in small children, so that made me feel a lot better.  You were definitely right.  I appreciate the comment!  

[Ken_PA]

Hi, it doesn't seem like CLL because you haven't stated that the lymphocytes are high, and also the smudge cells are not numerous but are instead rare. Besides, CLL would be very rare at 14 mos.

Wasn't the smear done more than once to make sure there wasn't lab error?

[Belladeg]

The actual numbers say lymphocytes (%) auto 63.9 and then lymphocytes #  6.19.
I mean I’m not sure what those numbers mean. Maybe they are within range.

[Belladeg]

And thank you for explaining the rare part. We go on Wednesday So I’m hoping they will either do another one or things will be explained clearly with all the results. I understand it’s hard to interpret when you’re not seeing everything.