骨髓細胞學檢查課件

骨髓細胞學檢查BoneMarrowExamination(BME)骨髓細胞學檢查026contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination骨髓細胞學檢查026Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells骨髓細胞學檢查026Developmentofprogenitorcells原紅細胞早幼紅細胞中幼紅細胞晚幼紅細胞紅細胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒細胞早幼粒細胞中幼粒細胞晚幼粒細胞桿狀核分葉核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented

嗜酸性嗜堿性原單核細胞幼單核單核細胞原巨核細胞幼巨核細胞顆粒型巨核細胞產(chǎn)血小板型巨核細胞血小板原淋巴細胞幼淋巴細胞淋巴細胞骨髓細胞學檢查026骨髓細胞學檢查026IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，

multiplemyeloma(MM)

-Helpfuldiagnosis：

idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，

Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

骨髓細胞學檢查026SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

骨髓細胞學檢查026SpecimenscollectionMarrowaspirationMarrowbiopsy骨髓細胞學檢查026StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens骨髓細胞學檢查026BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells骨髓細胞學檢查026Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio骨髓細胞學檢查026ActiveproliferationN:E1:20

骨髓細胞學檢查026MarkedhyperplasiaN:E1:10

骨髓細胞學檢查026ExtremehyperplasiaN:E1:1

骨髓細胞學檢查026HypoplasiaN:E1:50

骨髓細胞學檢查026MarkedhypoplasiaN:E1:200

骨髓細胞學檢查026Countthe

megakaryocytes骨髓細胞學檢查026BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

骨髓細胞學檢查026OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells骨髓細胞學檢查026Bonemarrowreportandevaluation

骨髓細胞學檢查026DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

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

骨髓細胞學檢查026M: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骨髓細胞學檢查026Myeloidseries

50~60%ofnucleatedcells

celltype

rangemyeloblasts＜1%promyelocytes＜5%myelocytes＜15%metamyelocytes＜15%骨髓細胞學檢查026Erythroidseries

20%ofnucleatedcells

celltype

rangenormoblasts＜1%basophilicnormoblasts＜5%polychromaticnormoblasts＜10%orthothromaticnormoblasts＜10%骨髓細胞學檢查026Others’seriesLymphocytes：20%ofnucleatedcellsmonocytes：＜4%ofnucleatedcellsPlasmacells：＜2%ofnucleatedcellsMegakaryocytes：othercellsorparasites：骨髓細胞學檢查02