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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

Hematopoietic System- 1Bone Marrow Hematopoiesis

Linda F. Cunningham, MD

January 2, 2003

hematopoietic system bone marrow
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
slide
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

hematopoietic system bone marrow4
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
slides
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
clinical evaluation tests of bone marrow function
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

hematopoietic system bone marrow7
Hematopoietic SystemBone Marrow

Bone Marrow Core Biopsy

Cellularity and the architecture

Bone Marrow Aspiration

Cytology and maturation

slides8
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
slides9
Slides
  • Bone Marrow Aspiration
    • Rodak 67 Aspirate smear
    • Rodak # 68 Myeloblast, promyelocyte, myelocyte, and lymphocyte
    • Rodak #71 Bands and segs
hematopoiesis
Hematopoiesis

Key Terms

  • Stem cells
  • Precursors cells (Blasts)
  • Terms for each stage in the morphologic differentiation
hematopoiesis11
Proerythroblast

Basophilic erythroblast

Polychromatophilic erythroblast

Orthrochromatophic erythroblast

Reticulocyte

Erythrocyte

Myeloblast

Promyelocyte

Myelocyte

Metamyelocyte

Band cell

Mature granulocyte (neutrophil, eosinophil, or basophil)

Hematopoiesis
slides12
Slides
  • RBC Maturation
  • Harmening1-3
  • Histology 6.5
  • ASCP 2.6
  • 2.9
  • 2.7
  • 2.10
slides13
Slides
  • 2.12
  • 2.14
  • 2.15
  • CAP Polychromasia
  • CAP Reticulocyte stain
medical histology rbc maturation sequence
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
slides15
Slides
  • Diagram of red cell maturation and time sequence
  • Normal; red blood cells
  • CAP Polychromasia
  • CAP Reticulocyte stain
slides16
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
medical histology erythropoiesis
Medical Histology Erythropoiesis

Recognize the bone marrow response to anemia

  • Accelerated Erythropoiesis
    • Released Reticulocytes
  • Insufficient Erythropoiesis
    • Inadequate reticulocytes
medical histology bone marrow and red cell size
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
slides19
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
slides20
Slides
  • Rodak # 86 Iron Deficiency
  • ASCP 4-16 Iron Deficiency
  • ASCP 4- 20 Macrocytic with Lymphocyte
hematopoiesis21
Proerythroblast

Basophilic erythroblast

Polychromatophilic erythroblast

Orthrochromatophic erythroblast

Reticulocyte

Erythrocyte

Myeloblast

Promyelocyte

Myelocyte

Metamyelocyte

Band cell

Mature granulocyte (neutrophil, eosinophil, or basophil)

Hematopoiesis
slides22
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
medical histology neutrophilia and immature cells
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
slides24
Slides
  • Leukocytosis with left Shift
medical histology leukocyte maturation
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
slides26
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
slides27
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
platelet maturation
Platelet Maturation
  • Platelet fragmentation from megakaryocytes; these differentiated from megakaryoblasts
slides29
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
medical histology thrombocytopenia
Medical HistologyThrombocytopenia
  • Increased Destruction and Utilization
  • Impaired Production
slides31
Slides
  • ASCP BM:
  • Rodak 208 BM Aspirate with numerous megakaryocytes , but few or no platelets seen in the peripheral blood
hematopoiesis32
Hematopoiesis
  • Monocyte maturation from monoblast
  • Lymphocytes
question
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
question34
Question

Peripheral blood smear. Identify this cell

  • Nucleated red blood cell
  • Polychromatophilic red blood cell
  • Reticulocyte
  • Polymorphonuclear neutrophil
  • Eosinophil
question35
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
question36
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