骨髓細(xì)胞學(xué)檢查

1、骨髓細(xì)胞學(xué)檢查contentsThe developmental sequence of marrow cellsIndications and contraindications of bone marrow examinationSpecimens collectionSteps of bone marrow examinationReport and evaluation of bone marrow examinationThe developmental sequence of marrow cells Bone Marrow Blood Stem Cells Progenitor

2、cells Mature cells Erythroid Erythrocytes Myelomonocytic Neutrophils/monocytes Myeloid Eosinophil Eosinophils T stem cells Basophil Basophils S Megakaryocytes Platelets C Lymphoid Lymphoid Lymphocytes stem cells Development of progenitor cells原紅細(xì)胞 早幼紅細(xì)胞 中幼紅細(xì)胞 晚幼紅細(xì)胞 紅細(xì)胞normoblast basophilic polychrom

3、atic orthochromatic erythrocyte normoblast normoblast normoblast原粒細(xì)胞 早幼粒細(xì)胞 中幼粒細(xì)胞 晚幼粒細(xì)胞 桿狀核 分葉核myeloblast promyelocyte myelocyte metamyelocyte stab segmented 嗜酸性 嗜堿性原單核細(xì)胞 幼單核 單核細(xì)胞原巨核細(xì)胞 幼巨核細(xì)胞 顆粒型巨核細(xì)胞 產(chǎn)血小板型巨核細(xì)胞 血小板原淋巴細(xì)胞 幼淋巴細(xì)胞 淋巴細(xì)胞Indications of bone marrow examinationDiagnose hematologic diseases -Defi

4、nitive diagnosis： leukemia， multiple myeloma(MM) -Helpful diagnosis： idiopathic thrombocytopenic purpura(ITP)Diagnose non-hematologic diseases -Metabolic disorders：Gauchers disease， Niemann-Pick disease -Metastasis cancer Differential diagnosis of unexplained fever，enlarged liver，enlarged spleen etc

5、. Special considerationContraindication：severe bleeding disorders，for exle hemophilia Specimens collectionMarrow aspirationMarrow biopsySteps of bone marrow examinationBME under low power BME on oil lensBME under low powerAssesment the degrees of marrow hyperplasiaCount the number of megakaryocytes

6、Observe abnormal cells The degree of marrow hyperplasianucleated cells: erythrocytes ratio Active proliferationN:E 1:20 Marked hyperplasiaN:E 1:10 Extreme hyperplasiaN:E 1:1 HypoplasiaN:E 1:50 Marked hypoplasiaN:E 1:200 Count the megakaryocytesBME on oil lensMarrow differential count of 200 nucleate

7、d cells Morphologic examination of marrow cells Oil immersionCount the percentage of variouse cell types M:E ratio：the percentage of myeloid cells divided by the percentage of erythroide cellsBone marrow report and evaluation Degrees of marrow hyperplasiaNucleated cells : Erythrocytes 1:20 Degrees N

8、:E Causes extreme hyperplasia 1:1 leukemia marked hyperplasia 1:10 leukemia, hyperplastic anemia active proliferation 1:20 normal bone marrow, anemia hypoplasia 1:50 aplastic anemia(chronic) marked hypoplasia 1:200 aplastic anemia(acute) M:E ratioMyeloid series:Erythroid series 24:1 M:E Myeloid seri

9、es Erythroid series Causes 24:1 N N normal bone marrow MM , ITP erythroleukemia aplastic anemia(AA) 5:1 N AML or CML N pure red cell aplasia(PRCA) 2:1 N agranulocytosis N hyperplastic anemiaN=normal =increase =decreaseMyeloid series 5060% of nucleated cells cell type range myeloblasts 1% promyelocyt

10、es 5% myelocytes 15% metamyelocytes 15%Erythroid series 20% of nucleated cells cell type range normoblasts 1% basophilic normoblasts 5% polychromatic normoblasts 10% orthothromatic normoblasts 10%Others seriesLymphocytes： 20% of nucleated cellsmonocytes： 4% of nucleated cellsPlasma cells： 2% of nucleated cellsMegakaryocytes：other cells or parasites：Peripheral blood smearWBCs differential countMorphologic exam