1. Bone Marrow Examination
Nungruthai Nimnuch
School of Allied Health Sciences 1
Naresuan University Phayao

2. (Bone marrow)
F spongy tissue F
F
F
F
F F F
2

3. F F
F
F F F
F , F F F F
F F F
F staging F
F F lymphoreticular system F
F F
F F lymphoreticular
system
3

4. 3
1. F (Aspirtaion)
2. F (Needle Biopsy)
3. (Surgical Biopsy)
F
F (Sternum) F F 2-3
(Iliac crest) Anterior posterior iliac crest
(Spinous process) Anterior posterior
superior iliac spine
(Tibia)
4

5. 5

6. F?
F 15
F F 2 mm.
(bone marrow aspiration)
F F F F
F F F F
F F trephine biopsy
6

7. Bone marrow aspiration
7

8. F
F F
F EDTA tube F 30 F F
F
F
Push technique Pull technique
Push technique : F F spreader
Pull technique (squash preparation) : F glass slide 2 F F
Fixing and straining aspirate smear
F F F F metanol
Romanowsky stain : basic dye acid dye , , pH
staining buffer F F F F F 8

9. F F
(Bone marrow examination)
1. Bone marrow smear preparation
2. Bone marrow cellularity
3. Megakaryocyte
4. M:E ratio
5. Maturation myelocytic series erythrocytic series
6. Megaloblastoid change
7. Histiocyte
8. Plasma cells
9. Eosinophil
10. Blast cells Metastatic cells 9

10. F (Low magnification)
1.1 F F F low power field
fat cell megakaryocyte
Fat cell
Megakaryocte
1.2 Bone marrow smear preparation
clot
F F :
10

11. 1.3 Bone marrow cellularity
nucleated cell F F low power
field (10X) F
Normal cellularity
nucleated cell 2 4 F F
F F low power field
http://bonemarrowbiopsy.wordpress.com/normal-results/ 11

12. Hypocellularity
nucleated cell F F 1 4 F F
F F low power field
hypocellularity F aplastic anemia, myelofibrosis
12
www.medscape.com/viewarticle/430138_3

13. Hypercellularity
nucleated cell F 3 4 F F
F F low power field
F hypercellularity F F acute leukemia
http://img.medscape.com/fullsize/migrated/501/096/lab501096.fig4.jpg 13

14. Diluted specimen
F
F F F
F F F low power field
red blood cell F fat cell
megakaryocyte
14

15. 1.4 Megakaryocyte
megakaryocyte F
F F
1-15 cells/LPF
Megakaryocyte
15

16. F F F F F F
16

17. F (High magnification)
1.1 M:E ratio
F nucleated cell myeloid : nucleated cell
erythroid
F normal bone marrow M:E ratio = 3:1
F F 10 fields
Myeloid hyperplasia : F myeloid
F F (infection) M:E ratio
Erythroid hyperplasia : F erythroid
F F F F (anemia) M:E ratio
17

18. 1.2 Maturation myelocytic series
Normal
F myeloid F normal bone marrow F
metamyelocyte, band form segmented cell
metamyelocyte band form segmented cell
promyelocyte
Shift to the left
F F promyelocyte
18

19. 1.3 Maturation erythroid series
Normal
F erythroid F normal bone marrow F
polychromatic normoblast orthochromatic normoblast
polychromatic normoblast orthochromatic normoblast
basophilic normoblast
Shift to the left
F F basophilic normoblast
19

20. 1.4 Megaloblastoid change
F erythroid
B12 folate F F F F
1 F F
http://www.vet.uga.edu/vpp/clerk/Smith/index.php 20

21. 1.5 Histiocyte
Histiocyte F Reticuloendothelial cell (RE cell) F
F
F F 1% nucleated cell
F (infection) F plasma cell
eosinophil
Reactive histiocyte
Rhopheocytosis F F histiocyte
F F F
polychromatic normoblast F
F histiocyte 21

22. 1.6 Plasma cells
Plasma cell F F F
F F (eccentric) F (spongy)
F F 1% nucleated cell
F (infection)
plasma cell F F
F Multiple myeloma (MM) F
F monoclonal immunoglobulin (MoIg) F
MoIg F M-protein paraprotein
F Plasma cell
22

23. 1.7 Eosinophil
eosinophil F 1-5% nucleated cell F
eosinophil F F
Infection eosinophil infection F
histiocyte plasma cell
CML F Chronic Myelocytic Leukemia
eosinophil F
F F F F F
F F treatment F
eosinophil F F F F
differentiation F FF F (Well recovery)
Eosinophil
23

24. 1.8 Blast cells
blast cell F F 3%
nucleated cell
blast cell > 30% leukemia?
Pronormoblast Lymphoblast
Myeloblast Monoblast
24

25. 1.9 Metastatic cells
F
(metastasis)
Metastatic cells
25
http://www.healthsystem.virginia.edu/internet/hematology/hessidb/Rare-bone-marrow-findings.cfm

26. 26

27. 27