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026contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination骨髓细胞学检查026Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells骨髓细胞学检查026Developmentofprogenitorcells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骨髓细胞学检查026骨髓细胞学检查026IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，

multiplemyeloma(MM)

-Helpfuldiagnosis：

idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，

Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

骨髓细胞学检查026SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

骨髓细胞学检查026SpecimenscollectionMarrowaspirationMarrowbiopsy骨髓细胞学检查026StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens骨髓细胞学检查026BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells骨髓细胞学检查026Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio骨髓细胞学检查026ActiveproliferationN:E1:20

骨髓细胞学检查026MarkedhyperplasiaN:E1:10

骨髓细胞学检查026ExtremehyperplasiaN:E1:1

骨髓细胞学检查026HypoplasiaN:E1:50

骨髓细胞学检查026MarkedhypoplasiaN:E1:200

骨髓细胞学检查026Countthe

megakaryocytes骨髓细胞学检查026BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

骨髓细胞学检查026OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells骨髓细胞学检查026Bonemarrowreportandevaluation

骨髓细胞学检查026DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

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

骨髓细胞学检查026M: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骨髓细胞学检查026Myeloidseries

50~60%ofnucleatedcells

celltype

rangemyeloblasts＜1%promyelocytes＜5%myelocytes＜15%metamyelocytes＜15%骨髓细胞学检查026Erythroidseries

20%ofnucleatedcells

celltype

rangenormoblasts＜1%basophilicnormoblasts＜5%polychromaticnormoblasts＜10%orthothromaticnormoblasts＜10%骨髓细胞学检查026Others’seriesLymphocytes：20%ofnucleatedcellsmonocytes：＜4%ofnucleatedcellsPlasmacells：＜2%ofnucleatedcellsMegakaryocytes：othercellsorparasites：骨髓细胞学检查02