骨髓细胞学检查026-课件

骨髓细胞学检查BoneMarrowExamination(BME)..骨髓细胞学检查BoneMarrowExamination1contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination..contentsThedevelopmentalsequ2Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells..Thedevelopmentalsequenceof3Developmentofprogenitorcells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....5IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，multiplemyeloma(MM)

-Helpfuldiagnosis：idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

..Indicationsofbonemarrowexa6SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

..Specialconsideration..7SpecimenscollectionMarrowaspirationMarrowbiopsy..Specimenscollection..8StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens..Stepsofbonemarrowexaminati9BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells..BMEunderlowpower..10Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio..Thedegreeof

marrowhyp11ActiveproliferationN:E1:20

..Activeproliferation..12MarkedhyperplasiaN:E1:10

..Markedhyperplasia..13ExtremehyperplasiaN:E1:1

..Extremehyperplasia..14HypoplasiaN:E1:50

..Hypoplasia..15MarkedhypoplasiaN:E1:200

..Markedhypoplasia..16Countthe

megakaryocytes..Countthe

megakaryocytes.17BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

..BMEonoillens..18OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells..OilimmersionCountthepercent19Bonemarrowreportandevaluation

..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↓=decrease..M:EratioMyeloidseries:Erythr22Myeloidseries

50~60%ofnucleatedcells

celltype

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

20%ofnucleatedcells

celltype

rangenormoblasts＜1%basophilicnormoblasts＜5%polychromat