bone-marrow-examination

1BONEMARROWEXAMINATION2Contents1.Bonemarrowexamination2.Bloodandbonemarrowprofilesofsomehematologicaldiseases3BonemarrowexaminationIndicationsandCounterindicationsMethodsGeneralprofilesCloseinspectionofbloodcellprecursors4Indicationsforbonemarrowexamination1.furtherworkupofhematologicabnormalitiesobservedinbloodroutinetestorbloodsmear2.evaluationofprimaryBMtumors3.stagingforBMinvolvementbymetastatictumors4.assessmentofinfectiousdiseaseprocessesincludingfeverofunknownorigin5.evaluationofmetabolicstoragediseases6.toobtaincellsforcytogenetic,flowcytometryorimmunocytochemistrystudies.5CounterindicationforbonemarrowexaminationHemophiliaorseverebloodcoagulationfactordeficiencyInflammationorabnormityatthesiteofaspiration6Methodsforbonemarrowexamination7MethodsforbonemarrowexaminationBonemarrowaspiration:cytomorphology,cytogenetics,immunophenotype,molecularstudiesBonemarrowbiopsy:evaluationofBMcellularity,fibrosis,infectionsorinfiltrativediseases8GeneralprofileofBoneMarrow1.Themarrowspicules,fatdrop,nucleatedcellsandcellsspecialtothebonemarrow;2.Thecellularityofbonemarrow-themyeloidtoerythroidratio(M:E);3.Theproportionsofeachcelltypeandmaturationalsequence4.Specialcells,e.g.themetastaticmalignantcells,Niemann-Pickcellsandsoon.9CellularityofBoneMarrowHypercellularityNormalcellularityHypocellularityLowmagnificationdistributionandfrequencyofmegakaryocytes10VariationsinthecellularityofbonemarrowsmearsNormalBMhypercellularBMhypocellularBM11M:Eratio-2to4:1Thisnumericaldesignationprovidesanapproximationofthemyeloidelementsinthemarrowandtheirprecursorcellsandtheerythroidelementsinthemarrowandtheirprecursorcells.Itsensitivestohematologicalfactorsthatmayimpairredcelllife,inhibitoverallproduction,orcausedramaticincreaseinaparticularcellline.myeloidtoerythroid(M:E)ratio12myeloidtoerythroid(M:E)ratioNormalM:Eratio-normalBM,diseaseswithparallelchangesinthetwocelllinesanddiseaseswithnoalterationinmeyloidanderythroidcells.AA,ITP,MM,etc.IncreasedM:Eratio-diseaseswithincreasedmyeloidcellsorreducederythroidcells:infection、AML,CML,pureredcellaplasticanemiaetc.DecreasedM:Eratio-diseaseswithincreasederythroidcellsorreducedmeyloidcells:granulocytopenia,hyperplasiaanemias,erythrocytosis.13CloseinspectionofbloodcellprecursorsHematopoiesisErythrocytedevelopmentGranulocytedevelopmentMonocytedevelopmentLymphocytedevelopmentOilimmersionMorphology:CellsizeNuclearmorphologyHemoglobindevelopment14HematopoiesisHematopoiesisisdefinedastheproduction,development,differentiationandmaturationofallbloodcells.Thesitesofhematopoiesis:fetallife-yolksack,liver,spleenadult-bonemarrow-intramedullaryliver,spleen-extramedullary1516ErythrocyteDevelopment-ErythropoiesisProerthroblast(pronormoblast)StemcellLatestemcellBasophilicerythroblastPolychromatophilicerythroblastOrthocromatophilicerythroblast(Normoblast)ReticulocyteMatureerythrocyte17ErythrocyteDevelopment-Erythropoiesis18GranulocytedevelopmentPromyelocyteMyelocyteBandcellMatureneutrophilMyeloblastMetamyelocyteStemcell19MonocyteDevelopmentStemCellMonoblastPromonocyteMonocyte20MonocytesoMonocytesarephagocyticwhitebloodcells.Asthebelowpicturesillustrate,theycanvaryinsize,from16-20micrometersindiameter.Theyaredistinguishedbytheirkidneyshaped,oftenfoldednuclei.21MatureMonocytes22LymphocyteDevelopmentLymphocyticprogenitorsoriginateinbonemarrow.Lymphocytessplitofftotheirownlineofstemcellsquiteearlyindevelopment,thusthelymphocytesareconsideredaseparatelinefromtheentirecollectionofmyeloidcellsDifferentialStages:Lymphoblast.Prolymphocytes.B-orT-lymphocytes23LymphocyteDevelopmentStemCellLymphoblastProlymphocyteLarge(yellowa)andSmall(greena)Lymphocytes24Cytochemicalstains:25bonemarrowprofilesofsomehematologicaldiseases26AnemiaMorphologicalclassificationofanemia:normocyticnormochromicanemiamicrocytichypochromicanemiamicrocyticnormochromicanemiamacrocyticnormochromicanemiaDefinition:areductioninthehemoglobinconcentrationintheblood27IronDeficiencyAnemia(IDA)MegaloblasticAnemiaHemolyticAnemia(HA)AplasticAnemia(AA)Anemia28Inirondeficiencytheredbloodcellsaresmallerthannormal(microcytic)andcontainreducedamountsofhemoglobin(hypochromic).IronDeficiencyAnemia(IDA)-peripheralbloodHb/Hct/RBCMCVMCHMCHCreticulocytesBlood29Inirondeficiencythelatestagenormoblastsarepoorlyhemoglobinated.Thecytoplasmremainsbluetogreyratherthanyelloworange.Cellularity&EarlyStageOfErythrocyteBonemarrowIronDeficiencyAnemia(IDA)-bonemarrow30IronDeficiencyAnemia(IDA)-ironstainingnormalcoarsegranularirondepositsinamacrophageAbsenceofironstoresinBMfragmentsduetosevereirondeficiency31MegaloblasticAnemiacharacterizedbythepresenceofabnormalmegaloblastsinBMwhichdifferfromnormalerythroblastsintheirsizeandnuclearstructure.Themegakaryocytesandgranulocytesarehypersegmentedandthemetamyelocytesandbandformsareabnormallylarge.Causes:deficiencyofvitB12orfolatesorrelatedconditionsthatleadtoimpairedDNAsynthesis32Hb/Hct/RBC&MCVMCH&ShifttoRightBloodMegaloblasticAnemia-peripheralbloodBloodfilminVitB12deficiencyshowingmacrocyticRedcellsandahypersegmented