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Hematopoietic System- 1 Bone Marrow Hematopoiesis

Hematopoietic System- 1 Bone Marrow Hematopoiesis. Linda F. Cunningham, MD January 2, 2003. Hematopoietic System Bone Marrow. Hematopoietic active marrow with stem cells, progenitor cells, and developing erythroblasts, myeloblasts, and megakaryoblasts (red marrow)

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Hematopoietic System- 1 Bone Marrow Hematopoiesis

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  1. Hematopoietic System- 1Bone Marrow Hematopoiesis Linda F. Cunningham, MD January 2, 2003

  2. Hematopoietic SystemBone Marrow • Hematopoietic active marrow with stem cells, progenitor cells, and developing erythroblasts, myeloblasts, and megakaryoblasts (red marrow) • Adipose cells, various with age and activity (yellow marrow) • Marrow sinuses and capillary network

  3. Slide • ASCP Bone Marrow 3: • Histology 6.2: Trabecular bone with hematopoietic tissue and fat • Rodak 7 Bone Marrow with hematopoietic tissue, capillaries, and fat Rodak #76 Core Biopsy shows 50 % fat and 50 % hematopoietic tissue

  4. Hematopoietic SystemBone Marrow • Amount of red marrow varies with age of patient • Childhood: Red marrow is 100% of BM and present in virtually every bone • Adults: Red marrow is ~50% of BM and present in sternum, ribs, pelvis, and skull • ~70 years: Red marrow reduced to ~ 30% of the BM

  5. Slides • Slide -Changes in site for Hematopoiesis with age • Bone Marrow in Skeleton Rodak 4 • Bone Marrow Biopsy Site Rodak 66 • ASCP Bone Marrow 13: Cellular, 5 y.o • 14: Less Cellular 35 y.o. • 30: Hypocellular, aplastic anemia

  6. Clinical Evaluation Tests of Bone Marrow Function Small amounts of myeloid tissue (myelos=marrow) is removed from bone cavity and examined under the microscope- Bone marrow aspiration Bone marrow biopsy

  7. Hematopoietic SystemBone Marrow Bone Marrow Core Biopsy Cellularity and the architecture Bone Marrow Aspiration Cytology and maturation

  8. Slides • Rodak 76: Core biopsy; Cellularity 50% • ASCP BM 237: AIDS granuloma • #204: Spindle cells • Robbins #338 Hypoplastic • Pathology 13.26 Hyperplastic • Pathology 13.27 Hyperplastic due to acute leukemia

  9. Slides • Bone Marrow Aspiration • Rodak 67 Aspirate smear • Rodak # 68 Myeloblast, promyelocyte, myelocyte, and lymphocyte • Rodak #71 Bands and segs

  10. Hematopoiesis Key Terms • Stem cells • Precursors cells (Blasts) • Terms for each stage in the morphologic differentiation

  11. Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthrochromatophic erythroblast Reticulocyte Erythrocyte Myeloblast Promyelocyte Myelocyte Metamyelocyte Band cell Mature granulocyte (neutrophil, eosinophil, or basophil) Hematopoiesis

  12. Slides • RBC Maturation • Harmening1-3 • Histology 6.5 • ASCP 2.6 • 2.9 • 2.7 • 2.10

  13. Slides • 2.12 • 2.14 • 2.15 • CAP Polychromasia • CAP Reticulocyte stain

  14. Medical HistologyRBC Maturation Sequence The red cell maturation sequence and significance of the change in red cell size and cytoplasmic color • Polychromatophilic red blood cells to illustrate newly released red cells • Reticulocytes to illustrate bone marrow response to anemia • Nucleated red blood cells in peripheral blood to illustrated bone marrow stress

  15. Slides • Diagram of red cell maturation and time sequence • Normal; red blood cells • CAP Polychromasia • CAP Reticulocyte stain

  16. Slides • ASCP 4-30 Polychromatophilic RBC with basophilic • ASCP 2-17 Reticulocyte stained with methylene blue • ASCP 2-18 Normal mature RBC • ASCP4-33 and 34 RBC and Rete stain • CAP: Nucleated red blood cell

  17. Medical Histology Erythropoiesis Recognize the bone marrow response to anemia • Accelerated Erythropoiesis • Released Reticulocytes • Insufficient Erythropoiesis • Inadequate reticulocytes

  18. Medical Histology Bone Marrow and Red Cell Size • Recognize the clinical significance of size of red cells • Recognize the size change with maturation • Classify anemia based on red cell size • Small = Microcytic • Large = Macrocytic • Normal = Normocytic

  19. Slides • Histology Figure 6-5 Stages • ASCP 2-06 Pronormoblast and orthroblast • ASCP 2-12 Orthro and polychrom • ASCP 2-15 Poly, orthro, polychromatophilic RBC • ASCP 2-14 Orthro losing its nucleus, late poly

  20. Slides • Rodak # 86 Iron Deficiency • ASCP 4-16 Iron Deficiency • ASCP 4- 20 Macrocytic with Lymphocyte

  21. Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthrochromatophic erythroblast Reticulocyte Erythrocyte Myeloblast Promyelocyte Myelocyte Metamyelocyte Band cell Mature granulocyte (neutrophil, eosinophil, or basophil) Hematopoiesis

  22. Slides • Histology 6.8 all stages • Harmening 1-17: Blast, promyelocyte, myelocyte, metamyelocyte, band, segmented; eosinophil myelocyte, metamyelocyte, band, and mature eosinophil • ASCP 2-22: Myeloblast and promyelocyte • ASCP 2-25 Promyelocyte, myelocyte, band, segmented neutrophil

  23. Medical HistologyNeutrophilia and Immature Cells • Leukocyte Maturation and Response to Infection produces a left shifted maturation: early cells in the peripheral blood • Increased numbers of neutrophils leave the bone marrow storage spaces • Increased neutrophil production • Immature forms - bands, metamyelocytes, and even myelocytes leave the bone marrow

  24. Slides • Leukocytosis with left Shift

  25. Medical HistologyLeukocyte Maturation Leukemia and Maturation of Leukocytosis • Acute Leukemia: Immature cells • Granulocyte maturation AML • Lymphocyte maturation ALL • Chronic Leukemia: Mature cells • Granulocyte maturation CML • Lymphocyte maturation CLL

  26. Slides • Saunders # 349 Lack of maturation, monotonous population, acute leukemia • CAP HE-23 Mature lymphocyte and lymphoblast • ASCP 6-10 Maturation of granulocytic cells in CGL

  27. Slides • Cancer 13.18 Maturation of granulocytic cells • ASCP 6-40 Maturation of granulocytic cells • ASCP 6-45 and 6-46 CLL monotonous population • CAP HE-25 Normal lymphocyte • Saunders #353 CLL

  28. Platelet Maturation • Platelet fragmentation from megakaryocytes; these differentiated from megakaryoblasts

  29. Slides • ASCP 2-49 Megakaryocyte Identification • ASCP 2-52 Active (Platelet forming) Bone Marrow Megakaryocytes • ASCP 2-53 Platelets in bone marrow last of the platelets released; nucleus remains

  30. Medical HistologyThrombocytopenia • Increased Destruction and Utilization • Impaired Production

  31. Slides • ASCP BM: • Rodak 208 BM Aspirate with numerous megakaryocytes , but few or no platelets seen in the peripheral blood

  32. Hematopoiesis • Monocyte maturation from monoblast • Lymphocytes

  33. Question A 54 year old man has a neoplastic disorder that shows a peripheral blood leukocytosis with a predominance of mature neutrophils, few myelocytes, metamyelocytes, and promyelocytes. Myeloblasts are not identified What is the most likely diagnosis? • Acute leukemia • Chronic leukemia • Lymphoma

  34. Question Peripheral blood smear. Identify this cell • Nucleated red blood cell • Polychromatophilic red blood cell • Reticulocyte • Polymorphonuclear neutrophil • Eosinophil

  35. Question This basophilic staining large cell is present in the peripheral blood of a patient appropriately treated for anemia. What is the most like cause for this coloration? • Iron granules • Neoplastic primary granules • Residual DNA • Residual RNA

  36. Question Which of the following hematologic evaluations is most likely to give useful information about the maturation and cytology of the erythroid and granulocytic series? • Bone marrow aspiration • Bone marrow core biopsy • Complete blood cell count

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