骨髓細(xì)胞學(xué)檢查課件

骨髓細(xì)胞學(xué)檢查BoneMarrowExamination(BME)骨髓細(xì)胞學(xué)檢查026contentsThedevelopmentalsequenceofmarrowcellsIndicationsandcontraindicationsofbonemarrowexaminationSpecimenscollectionStepsofbonemarrowexaminationReportandevaluationofbonemarrowexamination骨髓細(xì)胞學(xué)檢查026Thedevelopmentalsequenceofmarrowcells

BoneMarrowBloodStemCells

Progenitorcells

Maturecells

Erythroid~ErythrocytesMyelomonocytic~Neutrophils/monocytesMyeloidEosinophil~Eosinophils

TstemcellsBasophil~Basophils

SMegakaryocytesPlatelets

CLymphoidLymphoid~Lymphocytesstemcells骨髓細(xì)胞學(xué)檢查026Developmentofprogenitorcells原紅細(xì)胞早幼紅細(xì)胞中幼紅細(xì)胞晚幼紅細(xì)胞紅細(xì)胞normoblastbasophilicpolychromaticorthochromaticerythrocytenormoblastnormoblastnormoblast原粒細(xì)胞早幼粒細(xì)胞中幼粒細(xì)胞晚幼粒細(xì)胞桿狀核分葉核myeloblastpromyelocytemyelocytemetamyelocytestabsegmented

嗜酸性嗜堿性原單核細(xì)胞幼單核單核細(xì)胞原巨核細(xì)胞幼巨核細(xì)胞顆粒型巨核細(xì)胞產(chǎn)血小板型巨核細(xì)胞血小板原淋巴細(xì)胞幼淋巴細(xì)胞淋巴細(xì)胞骨髓細(xì)胞學(xué)檢查026骨髓細(xì)胞學(xué)檢查026IndicationsofbonemarrowexaminationDiagnosehematologicdiseases

-Definitivediagnosis：leukemia，

multiplemyeloma(MM)

-Helpfuldiagnosis：

idiopathicthrombocytopenicpurpura(ITP)Diagnosenon-hematologicdiseases

-Metabolicdisorders：Gaucher’sdisease，

Niemann-Pickdisease

-Metastasiscancer

Differentialdiagnosisofunexplainedfever，enlargedliver，enlargedspleenetc.

骨髓細(xì)胞學(xué)檢查026SpecialconsiderationContraindication：severebleedingdisorders，forexamplehemophilia

骨髓細(xì)胞學(xué)檢查026SpecimenscollectionMarrowaspirationMarrowbiopsy骨髓細(xì)胞學(xué)檢查026StepsofbonemarrowexaminationBMEunderlowpowerBMEonoillens骨髓細(xì)胞學(xué)檢查026BMEunderlowpowerAssesmentthedegreesofmarrowhyperplasiaCountthenumberofmegakaryocytesObserveabnormalcells骨髓細(xì)胞學(xué)檢查026Thedegreeof

marrowhyperplasianucleatedcells:erythrocytesratio骨髓細(xì)胞學(xué)檢查026ActiveproliferationN:E1:20

骨髓細(xì)胞學(xué)檢查026MarkedhyperplasiaN:E1:10

骨髓細(xì)胞學(xué)檢查026ExtremehyperplasiaN:E1:1

骨髓細(xì)胞學(xué)檢查026HypoplasiaN:E1:50

骨髓細(xì)胞學(xué)檢查026MarkedhypoplasiaN:E1:200

骨髓細(xì)胞學(xué)檢查026Countthe

megakaryocytes骨髓細(xì)胞學(xué)檢查026BMEonoillensMarrowdifferentialcountof200nucleatedcells

Morphologicexaminationofmarrowcells

骨髓細(xì)胞學(xué)檢查026OilimmersionCountthepercentageofvariousecelltypesM:Eratio：thepercentageofmyeloidcellsdividedbythepercentageoferythroidecells骨髓細(xì)胞學(xué)檢查026Bonemarrowreportandevaluation

骨髓細(xì)胞學(xué)檢查026DegreesofmarrowhyperplasiaNucleatedcells:Erythrocytes1:20

Degrees

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

骨髓細(xì)胞學(xué)檢查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骨髓細(xì)胞學(xué)檢查026Myeloidseries

50~60%ofnucleatedcells

celltype

rangemyeloblasts＜1%promyelocytes＜5%myelocytes＜15%metamyelocytes＜15%骨髓細(xì)胞學(xué)檢查026Erythroidseries

20%ofnucleatedcells

celltype

rangenormoblasts＜1%basophilicnormoblasts＜5%polychromaticnormoblasts＜10%orthothromaticnormoblasts＜10%骨髓細(xì)胞學(xué)檢查026Others’seriesLymphocytes：20%ofnucleatedcellsmonocytes：＜4%ofnucleatedcellsPlasmacells：＜2%ofnucleatedcellsMegakaryocytes：othercellsorparasites：骨髓細(xì)胞學(xué)檢查02