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Diagnosis is typically based on blood tests that find high numbers of mature lymphocytes and smudge cells. [5] This is an example of how a smudge cell looks on a peripheral blood smear, which is a common finding in patients with chronic lymphocytic leukemia (CLL).
Peripheral blood smear in patient with thrombotic thrombocytopenic purpura. Typical schistocytes are annotated. A schistocyte or schizocyte (from Greek schistos for "divided" and kytos for "hollow" or "cell") is a fragmented part of a red blood cell. Schistocytes are typically irregularly shaped, jagged, and have two pointed ends. [1]
Rouleaux formation on wet smear. Rouleaux (singular is rouleau) are stacks or aggregations of red blood cells (RBCs) that form because of the unique discoid shape of the cells in vertebrates. The flat surface of the discoid RBCs gives them a large surface area to make contact with and stick to each other; thus forming a rouleau.
In optical microscopy these cells appear to have a dark center (a central, hemoglobinized area) surrounded by a white ring (an area of relative pallor), followed by dark outer (peripheral) second ring containing a band of hemoglobin. However, in electron microscopy they appear very thin and bell shaped (hence the name codo-: bell).
Along with Döhle bodies and toxic vacuolation, which are two other findings in the cytoplasm of granulocytes, toxic granulation is a peripheral blood film finding suggestive of an inflammatory process. [1] Toxic granulation is often found in patients with bacterial infection and sepsis, [1] [2] although the finding is nonspecific. [3]
Reactive lymphocyte surrounded by red blood cells. In immunology, reactive lymphocytes, variant lymphocytes, atypical lymphocytes, Downey cells or Türk cells are cytotoxic (CD8 +) lymphocytes that become large as a result of antigen stimulation. Typically, they can be more than 30 μm in diameter with varying size and shape.
Acanthocytes, from peripheral blood, under light microscopy. Note the irregularly shaped, non-circular cells in the image. Acanthocyte (from the Greek word ἄκανθα acantha, meaning 'thorn'), in biology and medicine, refers to an abnormal form of red blood cell that has a spiked cell membrane, due to thorny projections.
Toxic vacuolation is associated with sepsis, particularly when accompanied by toxic granulation. [4] The finding is also associated with bacterial infection, [3] alcohol toxicity, liver failure, [4] and treatment with granulocyte colony-stimulating factor, a cytokine drug used to increase the absolute neutrophil count in patients with neutropenia.