骨髓細胞學檢查026-課件

骨髓細胞學檢查BoneMarrowExamination(BME)..骨髓細胞學檢查BoneMarrowExamination1contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination..contentsThedevelopmentalsequ2Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells..Thedevelopmentalsequenceof3Developmentofprogenitorcells原紅細胞早幼紅細胞中幼紅細胞晚幼紅細胞紅細胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒細胞早幼粒細胞中幼粒細胞晚幼粒細胞桿狀核分葉核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented嗜酸性嗜堿性原單核細胞幼單核單核細胞原巨核細胞幼巨核細胞顆粒型巨核細胞產(chǎn)血小板型巨核細胞血小板原淋巴細胞幼淋巴細胞淋巴細胞..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%polychromaticnormoblasts＜10%orthothromaticnormoblasts＜10%..Erythroidseries20%ofnucl24Others’seriesLymphocytes：20%ofnucleatedcellsmonocytes：＜4%ofnucleatedcellsPlasmacells：＜2%ofnucleatedcellsMegakaryocytes：othercellsorparasites：..Others’seriesLymphocytes：225PeripheralbloodsmearWBCsdifferentialcountMorphologicexaminationofRBCsPlatelets..PeripheralbloodsmearWBCsdif26MakeadiagnosisDefinitivediagnosisSupportivediagnosisDescriptivediagnosis..Makeadiagnosis..27ReviewIndicationsandcontraindicationStepsofBMEEvaluation..Review..28骨髓細胞學檢查BoneMarrowExamination(BME)..骨髓細胞學檢查BoneMarrowExamination29contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination..contentsThedevelopmentalsequ30Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells..Thedevelopmentalsequenceof31Developmentofprogenitorcells原紅細胞早幼紅細胞中幼紅細胞晚幼紅細胞紅細胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒細胞早幼粒細胞中幼粒細胞晚幼粒細胞桿狀核分葉核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented嗜酸性嗜堿性原單核細胞幼單核單核細胞原巨核細胞幼巨核細胞顆粒型巨核細胞產(chǎn)血小板型巨核細胞血小板原淋巴細胞幼淋巴細胞淋巴細胞..Developmentofprogenitorcell32....33IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，multiplemyeloma(MM)

-Helpfuldiagnosis：idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

..Indicationsofbonemarrowexa34SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

..Specialconsideration..35SpecimenscollectionMarrowaspirationMarrowbiopsy..Specimenscollection..36StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens..Stepsofbonemarrowexaminati37BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells..BMEunderlowpower..38Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio..Thedegreeof

marrowhyp39ActiveproliferationN:E1:20

..Activeproliferation..40MarkedhyperplasiaN:E1:10

..Markedhyperplasia..41ExtremehyperplasiaN:E1:1

..Extremehyperplasia..42HypoplasiaN:E1:50

..Hypoplasia..43MarkedhypoplasiaN:E1:200

..Markedhypoplasia..44Countthe

megakaryocytes..Countthe

megakaryocytes.45BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

..BMEonoillens..46OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells..OilimmersionCountthepercent47Bonemarrowreportandevaluation

..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↓Nagranulocytosis