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Bone Marrow Analysis Zhao xindong

Bone Marrow Analysis Zhao xindong. I. Degrees of marrow cellularity

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Bone Marrow Analysis Zhao xindong

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  1. Bone MarrowAnalysis Zhao xindong

  2. I. Degrees of marrow cellularity A.Marked or Moderate Hypercellularity 1.Malignant proliferation of abnormal cells 2.Hemopoietic hyperplasia (1)Hyperplastic anemia (2)Mageloblastic anemia

  3. B.Hypercellularity 1.Normal BM 2.Certain anemias

  4. C. Hypocellularity 1.Hemopoietic depression 2.Marrow diluted by blood

  5. Differential Diagnosis Hypoplasia BM diluted Naked eye BM granules * Rarely visible or fatty drop Microscopy Specific cells * Rarely visible of BM Band >segmented * Band < segmented Hemopoietic cells Hemopoietic islands, Megakryocytes Nonhemopoitic cells Plasma cell,Mast cell Osteoblast, Osteoclast

  6. II.M/E ratio • 1.M:E= ↑( ≥ 5:1) • (1)M ↑ :Infection,leukemoid reaction, AML,CML • (2)E ↓ :Pure red cell aplasia ( PRCA)

  7. 2.M:E = N (3~4:1 ) • (1)Normal marrow • (2)M ↑:E ↑ =N. Erythroleukemia, • Polycythemia vera • (PV ), CML • (3)M ↓:E ↓ =N. AA, Myelofibrosis, • MM,ALL

  8. 3.M :E = ↓ (≤ 2:1 ) or inversion (1)M↓: leukopenia, Neutropenia (2)E ↑: Hyperplastic Anemia MA,PV,Erythremia.

  9. Targets of Myeloid Hyperplasia • 1.Degrees of marrow cellularity. • 2.Myeloid to erythroid ratio • 3.Myeloid mitotic cells • 4.Myeloid series occupy % • of all nucleated cells.

  10. Morphologic Abnormalities • of Myeloid series • 1.Abnormal cell • 2.Abnormal nucleus • 3.Abnormal Cytoplasm

  11. 1、Abnormal cell (1)Abnormal shape (2) Development of nucleus and cytoplasm is disproportionate 2、Abnormal nucleus (1)Pelger-huet anomaly (2) Degeneration of nucleus (3) Hypersegmented neutrophils

  12. Pelger-Huet anomaly: All of the neutrophils have no more than a bi-lobed nucleus. The nuclear chromatin is coarsely clumped. It may be found in CML,MDS or inherited.

  13. Hypersegmented neutrophils

  14. 3、Abnormal cytoplasm • (1) Toxic granules • (2)Vacuoles • (3) Dohle bodies: • Inclusion body, • a small light blue-staining • area in cytoplasma of • neutrophil,is found in • infections, • poisoning, • burns • following chemotherapy.

  15. (4)Auer rods: are rod-like bodies that stain a reddish purple, they are found only in the cytoplasm of the blast cells in acute monocytic or acute myelogenous leukemia or MDS-RAEBt

  16. Myeloid Hyperplasia • --Myeloblasts ↑:AML,CML-CP, AMMoL • -- Promyelocytes ↑ :APL • -- Myelocytes ↑:M2b • -- Metamyelocytes and Bands ↑:CML

  17. Myeloid Hyperplasia • -- Eosinophilic Granulocytes ↑ • Allergic conditions • Parasitic infections • eosinophilic leukemia • chronic myelocytic leukemia

  18. Myeloid Hyperplasia --Basophilic Granulocytes ↑ basophilic leukemia chronic myelocytic leukemia

  19. Myeloid Hypoplasia • Neutropenia: hypoplasia, • mature suppression. • Aplastic Anemia. • Aplastic Crisis. Borrow marrow Examintion

  20. Erythroid Hyperplasia • Pronormoblast,Early normoblasts↑: • EL • Polychromatic normaoblasts and • Orthochromatic normaoblasts ↑ : • HA,IDA,MA • Orthochromatic normaoblasts ↑:IDA

  21. Targets of Erythroid • Hyperplasia. • Degrees of marrow cellularity. • Myeloid to erythroid ratio • Erythroid mitotic cells • Normoblasts occupy % of • all nucleated cells.

  22. Targets of Erythroid Maturation. • Late normoblasts ratio in erythron • Absolute reticulocytes in blood • RBC in blood.

  23. Erythroid Hypoplasia • Aplastic Anemia( AA) • Pure Red Cell Aplasia( PRCA) • Acute Arrest of Hemopoiesis. • ( AAH)

  24. Hyperplasia of Megakaryocytic Series • Megakaryblasts • >30% Ameg- L . • Megakaryocytes • CML,PV, Acute Hemorrhage. • Megakaryocytes with mature • depression. • ITP, Evan Syndrome

  25. Hypoplasia of Megakaryocytic Series • -- Acute leukemia • --AA • --Myelofibrosis

  26. Lymphocyte Series • 1.Lymphoblast and prolymphocyte • (1)ALL • (2)crisis of CLL • (3)Mixed acute leukemia • (MAL) • (4) Crisis of CML • (5) Prolymphocytic leukemia • (PLL) • (6)Lymphoma

  27. 2.Lymphocyte • (1) CLL • (2)Leukemoid reaction • (3)Infectious mononucleosis(IM) • (4)Infectious Lymphocytosis • (5)Virus Infections

  28. Monocyte series • 1.Monoblast • (1)Acute monocytic leukemia • (AMOL) • (2)Acute Myelomonocytic • leukemia (AMMOL)

  29. 2.Promonocyte • (1) Acute monocytic leukemia • (2) MDS-CMMOL • (3)Malignant tumor.

  30. Monocyte series • 3.Monocyte • (1) Leukomoid Reaction • (2) maligant tumor

  31. Plasmatic series 1.Plasmablast and Proplasmacyte (1)Multiple Myeloma (MM) (2) Plasma cell leukemia (PCL) 2.Plasmacyte (1)ITP (2) AA (3)Waldenstron’s macroglobulinemia

  32. Histocytosis • (1)Malignant Histocytosis(MH) • (2)Histocytic type Lymphoma • (3)Infectious diseases

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