骨髓細胞學檢查課件

骨髓細胞學檢查BoneMarrowExamination(BME)骨髓細胞學檢查BoneMarrowExamination1contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexaminationcontentsThedevelopmentalsequ2Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~LymphocytesstemcellsThedevelopmentalsequenceof3Developmentofprogenitorcells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骨髓細胞學檢查課件5骨髓細胞學檢查課件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骨髓細胞學檢查BoneMarrowExamination(BME)骨髓細胞學檢查BoneMarrowExamination29contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexaminationcontentsThedevelopmentalsequ30Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~LymphocytesstemcellsThedevelopmentalsequenceof31Developmentofprogenitorcells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骨髓細胞學檢查課件33骨髓細胞學檢查課件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