bone marrow analysis zhao xindong. i. degrees of marrow cellularity a.marked or moderate...
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Bone Marrow Analys
is
Zhao xindong
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
B.Hypercellularity
1.Normal BM 2.Certain anemias
C. Hypocellularity
1.Hemopoietic depression
2.Marrow diluted by blood
Differential Diagnosis Hypoplasia BM diluted Naked eye BM granules * Rarely visible or fatty dropMicroscopy Specific cells * Rarely visible of BM Band >segmented * Band < segmented
Hemopoietic cells Hemopoietic islands, MegakryocytesNonhemopoitic cells Plasma cell,Mast cell Osteoblast, Osteoclast
II.M/E ratio1.M:E= ↑( ≥ 5:1)
(1)M ↑ :Infection,leukemoid reaction, AML,CML(2)E ↓ :Pure red cell aplasia ( PRCA)
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
3.M :E = ↓ (≤ 2:1 ) or inversion
(1)M↓: leukopenia, Neutropenia
(2)E ↑: Hyperplastic Anemia
MA,PV,Erythremia.
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.
Morphologic Abnormalities
of Myeloid series
1.Abnormal cell
2.Abnormal nucleus
3.Abnormal Cytoplasm
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
Pelger-Huet anomaly: All of the neutrophils have no more than a bi-lobed nuc
leus. The nuclear chromatin is coarsely clumped. It may be found in CML,MDS or inherited.
Hypersegmented neutrophils
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.
(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
Myeloid Hyperplasia
--Myeloblasts ↑:AML,CML-CP, AMMoL
-- Promyelocytes ↑ :APL
-- Myelocytes ↑:M2b
-- Metamyelocytes and Bands ↑:CML
Myeloid Hyperplasia
-- Eosinophilic Granulocytes ↑ Allergic conditions Parasitic infections eosinophilic leukemia chronic myelocytic leukemia
Myeloid Hyperplasia
--Basophilic Granulocytes ↑
basophilic leukemia
chronic myelocytic leukemia
B o r r o w m a r r o w E x a m i n t i o n
Myeloid Hypoplasia
Neutropenia: hypoplasia, mature suppression.Aplastic Anemia. Aplastic Crisis.
Erythroid Hyperplasia
Pronormoblast,Early normoblasts↑: EL Polychromatic normaoblasts and Orthochromatic normaoblasts ↑ : HA,IDA,MA Orthochromatic normaoblasts ↑:IDA
Targets of Erythroid Hyperplasia.
Degrees of marrow cellularity.Myeloid to erythroid ratioErythroid mitotic cellsNormoblasts occupy % of all nucleated cells.
Targets of Erythroid Maturation.
Late normoblasts ratio in erythron
Absolute reticulocytes in blood
RBC in blood.
Erythroid Hypoplasia
Aplastic Anemia( AA)
Pure Red Cell Aplasia( PRCA)
Acute Arrest of Hemopoiesis. ( AAH)
Hyperplasia of Megakaryocytic Serie
s Megakaryblasts
>30% Ameg- L .
Megakaryocytes
CML,PV, Acute Hemorrhage.
Megakaryocytes with mature
depression.
ITP, Evan Syndrome
Hypoplasia of Megakaryocytic Series
-- Acute leukemia --AA --Myelofibrosis
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
2.Lymphocyte (1) CLL (2)Leukemoid reaction (3)Infectious mononucleosis(IM) (4)Infectious Lymphocytosis (5)Virus Infections
Monocyte series
1.Monoblast (1)Acute monocytic leukemia (AMOL) (2)Acute Myelomonocytic leukemia (AMMOL)
2.Promonocyte
(1) Acute monocytic leukemia
(2) MDS-CMMOL
(3)Malignant tumor.
Monocyte series
3.Monocyte (1) Leukomoid Reaction
(2) maligant tumor
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
Histocytosis
(1)Malignant Histocytosis(MH)
(2)Histocytic type Lymphoma
(3)Infectious diseases