骨髓细胞学检查

1. 骨髓细胞学检查 Bone Marrow Examination (BME)

2. contents • The developmental sequence of marrow cells • Indications and contraindications of bone marrow examination • Specimens collection • Steps of bone marrow examination • Report and evaluation of bone marrow examination

3. The developmental sequence of marrow cells Bone Marrow Blood Stem CellsProgenitor cellsMature cells Erythroid ~ Erythrocytes Myelomonocytic ~ Neutrophils/monocytes Myeloid Eosinophil ~ Eosinophils T stem cells Basophil ~ Basophils S Megakaryocytes Platelets C Lymphoid Lymphoid ~ Lymphocytes stem cells

4. Development of progenitor cells 原红细胞 早幼红细胞 中幼红细胞 晚幼红细胞 红细胞 normoblast basophilic polychromatic orthochromatic erythrocyte normoblast normoblast normoblast 原粒细胞 早幼粒细胞 中幼粒细胞 晚幼粒细胞 杆状核 分叶核 myeloblast promyelocyte myelocyte metamyelocyte stab segmented 嗜酸性 嗜碱性 原单核细胞 幼单核 单核细胞 原巨核细胞 幼巨核细胞 颗粒型巨核细胞 产血小板型巨核细胞 血小板 原淋巴细胞 幼淋巴细胞 淋巴细胞

6. Indications of bone marrow examination • Diagnose hematologic diseases -Definitive diagnosis： leukemia， multiple myeloma(MM) -Helpful diagnosis：idiopathic thrombocytopenic purpura(ITP) • Diagnose non-hematologic diseases -Metabolic disorders：Gaucher’s disease， Niemann-Pick disease -Metastasis cancer • Differential diagnosis of unexplained fever，enlarged liver，enlarged spleen etc.

7. Special consideration • Contraindication：severe bleeding disorders，for example hemophilia

8. Specimens collection • Marrow aspiration • Marrow biopsy

9. Steps of bone marrow examination • BME under low power • BME on oil lens

10. BME under low power • Assesment the degrees of marrow hyperplasia • Count the number of megakaryocytes • Observe abnormal cells

11. The degree of marrow hyperplasia • nucleated cells: erythrocytes ratio

12. Active proliferation • N:E 1:20

13. Marked hyperplasia • N:E 1:10

14. Extreme hyperplasia • N:E 1:1

15. Hypoplasia • N:E 1:50

16. Marked hypoplasia • N:E 1:200

17. Count the megakaryocytes

18. BME on oil lens • Marrow differential count of 200 nucleated cells • Morphologic examination of marrow cells

19. Oil immersion • Count the percentage of variouse cell types • M:E ratio：the percentage of myeloid cells divided by the percentage of erythroide cells

20. Bone marrow report and evaluation

21. Degrees of marrow hyperplasia • Nucleated cells : Erythrocytes 1:20 DegreesN: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)

22. M:E ratio • Myeloid series:Erythroid series 2~4:1 ────────────────────────────── M:E Myeloid series Erythroid series Causes ────────────────────────────── 2~4:1 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 anemia N=normal ↑=increase ↓=decrease

23. Myeloid series • 50~60% of nucleated cells cell typerange myeloblasts ＜1% promyelocytes ＜5% myelocytes ＜15% metamyelocytes ＜15%

24. Erythroid series • 20% of nucleated cells cell typerange normoblasts ＜1% basophilic normoblasts ＜5% polychromatic normoblasts ＜10% orthothromatic normoblasts ＜10%

25. Others’ series • Lymphocytes： 20% of nucleated cells • monocytes： ＜4% of nucleated cells • Plasma cells： ＜2% of nucleated cells • Megakaryocytes： • other cells or parasites：

26. Peripheral blood smear • WBCs differential count • Morphologic examination of RBCs • Platelets

27. Make a diagnosis • Definitive diagnosis • Supportive diagnosis • Descriptive diagnosis

28. Review • Indications and contraindication • Steps of BME • Evaluation