骨髓細(xì)胞學(xué)檢查課件

骨髓細(xì)胞學(xué)檢查BoneMarrowExamination(BME)骨髓細(xì)胞學(xué)檢查BoneMarrowExamination1contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexaminationcontentsThedevelopmentalsequ2Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~LymphocytesstemcellsThedevelopmentalsequenceof3Developmentofprogenitorcells原紅細(xì)胞早幼紅細(xì)胞中幼紅細(xì)胞晚幼紅細(xì)胞紅細(xì)胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒細(xì)胞早幼粒細(xì)胞中幼粒細(xì)胞晚幼粒細(xì)胞桿狀核分葉核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented嗜酸性嗜堿性原單核細(xì)胞幼單核單核細(xì)胞原巨核細(xì)胞幼巨核細(xì)胞顆粒型巨核細(xì)胞產(chǎn)血小板型巨核細(xì)胞血小板原淋巴細(xì)胞幼淋巴細(xì)胞淋巴細(xì)胞Developmentofprogenitorcell4骨髓細(xì)胞學(xué)檢查課件5骨髓細(xì)胞學(xué)檢查課件6SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

Specialconsideration7SpecimenscollectionMarrowaspirationMarrowbiopsySpecimenscollection8StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillensStepsofbonemarrowexaminati9BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcellsBMEunderlowpower10Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratioThedegreeof

marrowhyp11ActiveproliferationN:E1:20

Activeproliferation12MarkedhyperplasiaN:E1:10

Markedhyperplasia13ExtremehyperplasiaN:E1:1

Extremehyperplasia14HypoplasiaN:E1:50

Hypoplasia15MarkedhypoplasiaN:E1:200

Markedhypoplasia16Countthe

megakaryocytesCountthe

megakaryocytes17BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

BMEonoillens18OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecellsOilimmersionCountthepercent19Bonemarrowreportandevaluation

Bonemarrowreportandevaluat20DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

N:ECauses─────────────────────────────extremehyperplasia1:1leukemiamarkedhyperplasia1:10leukemia,hyperplasticanemiaactiveproliferation1:20normalbonemarrow,anemiahypoplasia1:50aplasticanemia(chronic)markedhypoplasia1:200aplasticanemia(acute)

DegreesofmarrowhyperplasiaN21M:EratioMyeloidseries:Erythroidseries2~4:1

──────────────────────────────

M:EMyeloidseriesErythroidseriesCauses──────────────────────────────2~4:1NNnormalbonemarrowMM,ITP

↑

↑erythroleukemia

↓

↓aplasticanemia(AA)＞5:1↑NAMLorCMLN↓pureredcellaplasia(PRCA)＜2:1↓NagranulocytosisN↑hyperplasticanemiaN=normal↑=increase↓=decreaseM:EratioMyeloidseries:Erythr22Myeloidseries

50~60%ofnucleatedcells

celltype

rangemyeloblasts＜1%promyelocytes＜5%myelocytes＜15%metamyelocytes＜15%Myeloidseries50~60%ofnuc23Erythroidseries

20%ofnucleatedcells

celltype

rangenormoblasts＜1%basophilicnormoblasts＜5%polychromaticnormoblasts＜10%orthothromaticnormoblasts＜10%Erythroidseries20%ofnucl24Others’seriesLymphocytes：20%ofnucleatedcellsmonocytes：＜4%ofnucleatedcellsPlasmacells：＜2%ofnucleatedcellsMegakaryocytes：othercellsorparasites：Others’seriesLymphocytes：225Peripheralbloodsmear