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1、骨髓细胞学检查,Bone Marrow Examination (BME),contents,The developmental sequence of marrow cells Indications and contraindications of bone marrow examination Specimens collection Steps of bone marrow examination Report and evaluation of bone marrow examination,The developmental sequence of marrow cells,Bon
2、e Marrow Blood Stem Cells Progenitor cells Mature cells Erythroid Erythrocytes Myelomonocytic Neutrophils/monocytes Myeloid Eosinophil Eosinophils T stem cells Basophil Basophils S Megakaryocytes Platelets C Lymphoid Lymphoid Lymphocytes stem cells,Development of progenitor cells,原红细胞 早幼红细胞 中幼红细胞 晚幼
3、红细胞 红细胞 normoblast basophilic polychromatic orthochromatic erythrocyte normoblast normoblast normoblast 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 myeloblast promyelocyte myelocyte metamyelocyte stab segmented 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,Indications of bone marrow e
4、xamination,Diagnose hematologic diseases -Definitive diagnosis： leukemia， multiple myeloma(MM) -Helpful diagnosis： idiopathic thrombocytopenic purpura(ITP) Diagnose non-hematologic diseases -Metabolic disorders：Gauchers disease， Niemann-Pick disease -Metastasis cancer Differential diagnosis of unexp
5、lained fever，enlarged liver，enlarged spleen etc.,Special consideration,Contraindication：severe bleeding disorders，for example hemophilia,Specimens collection,Marrow aspiration Marrow biopsy,Steps of bone marrow examination,BME under low power BME on oil lens,BME under low power,Assesment the degrees
6、 of marrow hyperplasia Count the number of megakaryocytes Observe abnormal cells,The degree of marrow hyperplasia,nucleated cells: erythrocytes ratio,Active proliferation,N:E 1:20,Marked hyperplasia,N:E 1:10,Extreme hyperplasia,N:E 1:1,Hypoplasia,N:E 1:50,Marked hypoplasia,N:E 1:200,Count the megaka
7、ryocytes,BME on oil lens,Marrow differential count of 200 nucleated cells Morphologic examination of marrow cells,Oil immersion,Count the percentage of variouse cell types M:E ratio：the percentage of myeloid cells divided by the percentage of erythroide cells,Bone marrow report and evaluation,Degree
8、s of marrow hyperplasia,Nucleated cells : Erythrocytes 1:20 Degrees N:E Causes extreme hyperplasia 1:1 leukemia marked hyperplasia 1:10 leukemia, hyperplastic anemia active proliferation 1:20 normal bone marrow, anemia hypoplasia 1:50 aplastic anemia(chronic) marked hypoplasia 1:200 aplastic anemia(
9、acute),M:E ratio,Myeloid series:Erythroid series 24:1 M:E Myeloid series Erythroid series Causes 24:1 N N normal bone marrow MM , ITP erythroleukemia aplastic anemia(AA) 5:1 N AML or CML N pure red cell aplasia(PRCA) 2:1 N agranulocytosis N hyperplastic anemia N=normal =increase =decrease,Myeloid se
10、ries,5060% of nucleated cells cell type range myeloblasts 1% promyelocytes 5% myelocytes 15% metamyelocytes 15%,Erythroid series,20% of nucleated cells cell type range normoblasts 1% basophilic normoblasts 5% polychromatic normoblasts 10% orthothromatic normoblasts 10%,Others series,Lymphocytes： 20%
11、 of nucleated cells monocytes： 4% of nucleated cells Plasma cells： 2% of nucleated cells Megakaryocytes： other cells or parasites：,Peripheral blood smear,WBCs differential count Morphologic examination of RBCs Platelets,Make a diagnosis,Definitive diagnosis Supportive diagnosis Descriptive diagnosis,Review,Indications and contraindication Steps of BME Evaluation,