授課用-骨髓細胞學檢查課件

1、骨髓細胞學檢查骨髓細胞學檢查contentsThe developmental sequence of marrow cellsIndications and contraindications of bone marrow examinationSpecimens collectionSteps of bone marrow examinationReport and evaluation of bone marrow examinationcontentsThe developmental sequThe developmental sequence of marrow cells Bon

2、e Marrow Blood Stem Cells Progenitor cells Mature cells Erythroid Erythrocytes Myelomonocytic Neutrophils/monocytes Myeloid Eosinophil Eosinophils T stem cells Basophil Basophils S Megakaryocytes Platelets C Lymphoid Lymphoid Lymphocytes stem cells The developmental sequence of Morphologic examinati

3、on of marrow cellsMyeloid series:Erythroid series 24:1 erythroleukemiaLymphocytes： 20% of nucleated cellspolychromatic normoblasts 10%Assesment the degrees of marrow hyperplasiaObserve abnormal cells2:1 N agranulocytosisMyeloid Eosinophil Eosinophils24:1 N N normal bone marrowMorphologic examination

4、 of marrow cells24:1 N N normal bone marrownormoblast basophilic polychromatic orthochromatic erythrocytecells divided by the percentage ofThe developmental sequence of marrow cellsDevelopment of progenitor cells原紅細胞 早幼紅細胞 中幼紅細胞 晚幼紅細胞 紅細胞normoblast basophilic polychromatic orthochromatic erythrocyte

5、 normoblast normoblast normoblast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myeloblast promyelocyte myelocyte metamyelocyte stab segmented 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Morphologic examination of mar授課用_骨髓細胞學檢查課件Indications of bone marrow examinationDiagnose hematologic di

6、seases -Definitive diagnosis： leukemia， multiple myeloma(MM) -Helpful diagnosis： idiopathic thrombocytopenic purpura(ITP)Diagnose non-hematologic diseases -Metabolic disorders：Gauchers disease， Niemann-Pick disease -Metastasis cancer Differential diagnosis of unexplained fever，enlarged liver，enlarge

7、d spleen etc. Indications of bone marrow exaSpecial considerationContraindication：severe bleeding disorders，for example hemophilia Special considerationSpecimens collectionMarrow aspirationMarrow biopsySpecimens collectionAssesment the degrees of marrow hyperplasiaSupportive diagnosisIndications and

8、 contraindications of bone marrow examinationN pure red cell aplasia(PRCA)Erythroid seriesmyeloblasts 1%Diagnose non-hematologic diseasesmonocytes： 4% of nucleated cellscells divided by the percentage ofMorphologic examination of marrow cellsNiemann-Pick diseasehypoplasia 1:50 aplastic anemia(chroni

9、c)T stem cells Basophil BasophilsStem Cells Progenitor cells Mature cells aplastic anemia(AA)Count the megakaryocytesmetamyelocytes 15%Steps of bone marrow examinationBME under low power BME on oil lensAssesment the degrees of marroBME under low powerAssesment the degrees of marrow hyperplasiaCount

10、the number of megakaryocytes Observe abnormal cells BME under low powerThe degree of marrow hyperplasianucleated cells: erythrocytes ratio The degree of marrow hypActive proliferationN:E 1:20 Active proliferationMarked hyperplasiaN:E 1:10 Marked hyperplasiaExtreme hyperplasiaN:E 1:1 Extreme hyperpla

11、siaHypoplasiaN:E 1:50 HypoplasiaMarked hypoplasiaN:E 1:200 Marked hypoplasiaCount the megakaryocytesCount the megakaryocytesBME on oil lensMarrow differential count of 200 nucleated cells Morphologic examination of marrow cells BME on oil lensOil immersionCount the percentage of variouse cell types

12、M:E ratio：the percentage of myeloid cells divided by the percentage of erythroide cellsOil immersionCount the percentBone marrow report and evaluation Bone marrow report and evaluatDegrees of marrow hyperplasiaNucleated cells : Erythrocytes 1:20 Degrees N:E Causes extreme hyperplasia 1:1 leukemia ma

13、rked 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) Degrees of marrow hyperplasiaNM:E ratioMyeloid series:Erythroid series 24:1 M:E Myeloid series Erythroid se

14、ries Causes 24:1 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 anemiaN=normal =increase =decreaseM:E ratioMyeloid series:ErythrMyeloid series 5060% of nucleated cells cell type range myeloblasts

15、 1% promyelocytes 5% myelocytes 15% metamyelocytes 15%Myeloid series 5060% of nucErythroid series 20% of nucleated cells cell type range normoblasts 1% basophilic normoblasts 5% polychromatic normoblasts 10% orthothromatic normoblasts 10%Erythroid series 20% of nuclOthers seriesLymphocytes： 20% of nucleated cellsmonocytes： 4% of nucleated cellsPlasma cells： 2% of nucleated cellsMegakaryocytes：other cells or parasites：Others seriesLymphocytes： 2Peripheral blood smearWBCs diff