骨髓細(xì)胞學(xué)檢查026-課件

骨髓細(xì)胞學(xué)檢查BoneMarrowExamination(BME)..骨髓細(xì)胞學(xué)檢查BoneMarrowExamination1contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination..contentsThedevelopmentalsequ2Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells..Thedevelopmentalsequenceof3Developmentofprogenitorcells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normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast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myeloblastpromyelocytemyelocytemetamyelocytestabsegmented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..Developmentofprogenitorcell4....5IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，multiplemyeloma(MM)

-Helpfuldiagnosis：idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

..Indicationsofbonemarrowexa6SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

..Specialconsideration..7SpecimenscollectionMarrowaspirationMarrowbiopsy..Specimenscollection..8StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens..Stepsofbonemarrowexaminati9BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells..BMEunderlowpower..10Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio..Thedegreeof

marrowhyp11ActiveproliferationN:E1:20

..Activeproliferation..12MarkedhyperplasiaN:E1:10

..Markedhyperplasia..13ExtremehyperplasiaN:E1:1

..Extremehyperplasia..14HypoplasiaN:E1:50

..Hypoplasia..15MarkedhypoplasiaN:E1:200

..Markedhypoplasia..16Countthe

megakaryocytes..Countthe

megakaryocytes.17BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

..BMEonoillens..18OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells..OilimmersionCountthepercent19Bonemarrowreportandevaluation

..Bonemarrowreportandevaluat20DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

N:ECauses─────────────────────────────extremehyperplasia1:1leukemiamarkedhyperplasia1:10leukemia,hyperplasticanemiaactiveproliferation1:20normalbonemarrow,anemiahypoplasia1:50aplasticanemia(chronic)markedhypoplasia1:200aplasticanemia(acute)

..DegreesofmarrowhyperplasiaN21M:EratioMyeloidseries:Erythroidseries2~4:1

──────────────────────────────

M:EMyeloidseriesErythroidseriesCauses──────────────────────────────2~4:1NNnormalbonemarrowMM,ITP

↑

↑erythroleukemia

↓

↓aplasticanemia(AA)＞5:1↑NAMLorCMLN↓pureredcellaplasia(PRCA)＜2:1↓NagranulocytosisN↑hyperplasticanemiaN=normal↑=increase↓=decrease..M:EratioMyeloidseries:Erythr22Myeloidseries

50~60%ofnucleatedcells

celltype

rangemyeloblasts＜1%promyelocytes＜5%myelocytes＜15%metamyelocytes＜15%..Myeloidseries50~60%ofnuc23Erythroidseries

20%ofnucleatedcells

celltype

rangenormoblasts＜1%basophilicnormoblasts＜5%polychromaticnormoblasts＜10%orthothromaticnormoblasts＜10%..Erythroidseries20%ofnucl24Others’seriesLymphocytes：20%ofnucleatedcellsmonocytes：＜4%ofnucleatedcellsPlasmacells：＜2%ofnucleatedcellsMegakaryocytes：othercellsorparasites：..Others’seriesLymphocytes：225PeripheralbloodsmearWBCsdifferentialcountMorphologicexaminationofRBCsPlatelets..PeripheralbloodsmearWBCsdif26MakeadiagnosisDefinitivediagnosisSupportivediagnosisDescriptivediagnosis..Makeadiagnosis..27ReviewIndicationsandcontraindicationStepsofBMEEvaluation..Review..28骨髓細(xì)胞學(xué)檢查BoneMarrowExamination(BME)..骨髓細(xì)胞學(xué)檢查BoneMarrowExamination29contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination..contentsThedevelopmentalsequ30Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells..Thedevelopmentalsequenceof31Developmentofprogenitorcells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normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast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myeloblastpromyelocytemyelocytemetamyelocytestabsegmented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..Developmentofprogenitorcell32....33IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，multiplemyeloma(MM)

-Helpfuldiagnosis：idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

..Indicationsofbonemarrowexa34SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

..Specialconsideration..35SpecimenscollectionMarrowaspirationMarrowbiopsy..Specimenscollection..36StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens..Stepsofbonemarrowexaminati37BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells..BMEunderlowpower..38Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio..Thedegreeof

marrowhyp39ActiveproliferationN:E1:20

..Activeproliferation..40MarkedhyperplasiaN:E1:10

..Markedhyperplasia..41ExtremehyperplasiaN:E1:1

..Extremehyperplasia..42HypoplasiaN:E1:50

..Hypoplasia..43MarkedhypoplasiaN:E1:200

..Markedhypoplasia..44Countthe

megakaryocytes..Countthe

megakaryocytes.45BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

..BMEonoillens..46OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells..OilimmersionCountthepercent47Bonemarrowreportandevaluation

..Bonemarrowreportandevaluat48DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

N:ECauses─────────────────────────────extremehyperplasia1:1leukemiamarkedhyperplasia1:10leukemia,hyperplasticanemiaactiveproliferation1:20normalbonemarrow,anemiahypoplasia1:50aplasticanemia(chronic)markedhypoplasia1:200aplasticanemia(acute)

..DegreesofmarrowhyperplasiaN49M:EratioMyeloidseries:Erythroidseries2~4:1

──────────────────────────────

M:EMyeloidseriesErythroidseriesCauses──────────────────────────────2~4:1NNnormalbonemarrowMM,ITP

↑

↑erythroleukemia

↓

↓aplasticanemia(AA)＞5:1↑NAMLorCMLN↓pureredcellaplasia(PRCA)＜2:1↓Nagranulocytosis