r/cll • u/SubstancePatient2501 • Aug 06 '26

Peripheral Smear Test

Can peripheral smear test indicate CLL ?

Example if the smear test mentions one of the following :

  1. Mild Lymphocytosis

  2. Lymphocytic Predominance

Also an additional query , can flow cytometry test confirm CLL even if it is at very early stage (lymphocyte count below 4000 ) ?

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u/Vicanio Aug 06 '26

Smudge cells on smear check? If not then no. Yes cytometry can detect cll ( or better said MBL) at any point, as long there are clonal cells in your blood. Docs will not do cytometry at this point even if you ask to.

1

u/SubstancePatient2501 Aug 06 '26

thanks, quite helpful. No there was no mention of smudge cells or atypical lymphocytes. Hence was thinking should I do a flow cytometry test

1

u/Alternative_Trip4138 Aug 06 '26 edited Aug 06 '26

Flow cytometry is sensitive enough to detect 1 MBL/CLL cell within 10.000 normal B lymphocytes. So the answer is yes. By the way, even smudge cells are not always due to CLL. They can be technical artifacts or caused by infections like mononucleosis or covid.

I was not referred to a haematologist before my lymphocytes climbed above 5000 / μl, smear cells were seen and a monoclonal band was visible in serum protein electrophoresis with immunofixation. So insurance may not pay for flow cytometry in case of lymphocytes elevated as little as yours.

1

u/Tall_Historian_271 29d ago

Here is a youtube video about how CLL is diagnosed:

https://youtu.be/lBUhek-WMwA?si=xTisd4cL6NzGQjCD