Hello, I'd Like To Consult My Last Year CBC Results

Posted on Sun, 9 Jun 2019

Question: Hello, I'd like to consult my last year CBC results with a hematologist. I persistently had lymphocytosis and one test showed "smear cells " observed. The lymphocytosis has been between 6-6.6 x10^9 L. Other parameters normal. I had chronic tonsillitis (with yellow pus) for a few years that even changed the look of the tonsils. The tonsils were removed last year and the pathology confirmed "chronic tonsillitis" . My ENT specialist mentioned that lymphocytosis could be present in chronic tonsillitis - is that correct? or shall I be still worried about CLL/SLL. I will repeat the blood test this year . The attached reports are from before tonsillectomy. Thanks.

Answered by Dr. Shailja Puri (2 hours later)

Brief Answer:
Lymphocytosis with smear cell on PBS need further investigations.

Detailed Answer:
Hello,
Thanks for posting your query on Ask A Doctor service.
I have gone through your blood reports.

The blood reports show elevated lymphocyte count.
Chronic tonsillitis leading to lymphocytosis is less likely.
Lymphocytosis is commonly seen in viral infections.
As you have mentioned that one report showed 'smear cells'.
Thus, I suggest yopu to take a repeat complete blood count with peripheral blood smear (PBS) examination.
If the 'smear cells' persist in peripheral blood smear, flowcytometry is advised.
At the age of 35, malignancy is not expected, however, full investigations need to be done to know the cause of lymphocytosis.
Kindly, post me your latest complete blood count and peripheral blood count for interpretation.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Shailja Puri (18 hours later)

Thank you doctor. I shall repeat the test. In terms of ‘smear cells’ - do they only show up in CLL?

Answered by Dr. Shailja Puri (6 hours later)

Brief Answer:
Smear cells along with persistent lymphocytosis are suggestive of CLL.

Detailed Answer:
Hello and welcome again,
'Smear cells' or 'smudge cells' or 'basket cells' in appropriate clinical setting of persistent lymphocytosis, absence of infection are suggestive of chronic lymphocytic leukemia (CLL).
Isolated 'smear cells' in absence of other findings are not specific for CLL.
Thus, I suggested you to get a latest complete blood count along with peripheral blood smear examination.

Thanks and take care
Dr Shailja Puri

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Shailja Puri (13 hours later)

Thank you doctor. Yes I will repeat the test given that my infected tonsils have been removed and my total WBC count (when I still had my tonsils) oscillated between 10.4 - 14.6. The hospital count just before my surgery last year in August was the latest and showed WBC of 10.4 (but they didn’t mention anything about lymphocytes, only gave me the total count ). I’ll be in touch.

Answered by Dr. Shailja Puri (19 hours later)

Brief Answer:
An elevated white blood cell of 10.4 does not suggest any malignancy CLL.

Detailed Answer:
Hello and welcome again,
An elevated white blood cell (WBC) of 10.4 thousand cubic millimeter does not suggest any malignancy like CLL.
A differential count will be required to assess whether there is any abnormality.
In addition, a peripheral blood smear examination will be required to know the morphology of the cells.

Thanks and take care
Dr Shailja Puri

Note: Do you have more questions on diagnosis or treatment of blood disorders? Ask An Expert/ Specialist Now

Above answer was peer-reviewed by : Dr. Prasad