骨髓细胞学检查课件

骨髓细胞学检查BoneMarrowExamination(BME)骨髓细胞学检查BoneMarrowExamination1contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexaminationcontentsThedevelopmentalsequ2Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~LymphocytesstemcellsThedevelopmentalsequenceof3Developmentofprogenitorcells原红细胞早幼红细胞中幼红细胞晚幼红细胞红细胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒细胞早幼粒细胞中幼粒细胞晚幼粒细胞杆状核分叶核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented嗜酸性嗜碱性原单核细胞幼单核单核细胞原巨核细胞幼巨核细胞颗粒型巨核细胞产血小板型巨核细胞血小板原淋巴细胞幼淋巴细胞淋巴细胞Developmentofprogenitorcell4骨髓细胞学检查课件5骨髓细胞学检查课件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：225PeripheralbloodsmearWBCsdifferentialcountMorphologicexaminationofRBCsPlateletsPeripheralbloodsmearWBCsdif26MakeadiagnosisDefinitivediagnosisSupportivediagnosisDescriptivediagnosisMakeadiagnosis27ReviewIndicationsandcontraindicationStepsofBMEEvaluationReview28骨髓细胞学检查BoneMarrowExamination(BME)骨髓细胞学检查BoneMarrowExamination29contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexaminationcontentsThedevelopmentalsequ30Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~LymphocytesstemcellsThedevelopmentalsequenceof31Developmentofprogenitorcells原红细胞早幼红细胞中幼红细胞晚幼红细胞红细胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒细胞早幼粒细胞中幼粒细胞晚幼粒细胞杆状核分叶核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented嗜酸性嗜碱性原单核细胞幼单核单核细胞原巨核细胞幼巨核细胞颗粒型巨核细胞产血小板型巨核细胞血小板原淋巴细胞幼淋巴细胞淋巴细胞Developmentofprogenitorcell32骨髓细胞学检查课件33骨髓细胞学检查课件34SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

Specialconsideration35SpecimenscollectionMarrowaspirationMarrowbiopsySpecimenscollection36StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillensStepsofbonemarrowexaminati37BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcellsBMEunderlowpower38Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratioThedegreeof

marrowhyp39ActiveproliferationN:E1:20

Activeproliferation40MarkedhyperplasiaN:E1:10

Markedhyperplasia41ExtremehyperplasiaN:E1:1

Extremehyperplasia42HypoplasiaN:E1:50

Hypoplasia43MarkedhypoplasiaN:E1:200

Markedhypoplasia44Countthe

megakaryocytesCountthe

megakaryocytes45BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

BMEonoillens46OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecellsOilimmersionCountthepercent47Bonemarrowreportandevaluation

Bonemarrowreportandevaluat48DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

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

DegreesofmarrowhyperplasiaN49M:EratioMyeloidseries:Erythroidseries2~4:1

──────────────────────────────

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

↑

↑erythroleukemia

↓

↓aplasticanemia(AA)＞5:1↑NAMLorCMLN↓pureredcellaplasia(PRCA)＜2:1↓NagranulocytosisN↑hyperplasticanemiaN=normal↑=in