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1、骨髓细胞学检查第一页，本课件共有28页contentsThe developmental sequence of marrow cellsIndications and contraindications of bone marrow examinationSpecimens collectionSteps of bone marrow examinationReport and evaluation of bone marrow examination第二页，本课件共有28页The developmental sequence of marrow cells Bone Marrow Bloo
2、dBone Marrow Blood Stem Cells Stem Cells Progenitor cellsProgenitor cells Mature cellsMature cells Erythroid Erythrocytes Erythroid Erythrocytes Myelomonocytic Neutrophils/monocytes Myelomonocytic Neutrophils/monocytes Myeloid Eosinophil Eosinophils Myeloid Eosinophil Eosinophils T T stem cells Baso
3、phil Basophils stem cells Basophil Basophils S S Megakaryocytes Platelets Megakaryocytes Platelets C C Lymphoid Lymphoid Lymphocytes Lymphoid Lymphoid Lymphocytes stem cells stem cells 第三页，本课件共有28页Development of progenitor cells原红细胞原红细胞 早幼红细胞早幼红细胞 中幼红细胞中幼红细胞 晚幼红细胞晚幼红细胞 红细胞红细胞normoblast basophilic po
4、lychromatic orthochromatic erythrocytenormoblast basophilic polychromatic orthochromatic erythrocyte normoblast normoblast normoblast normoblast normoblast normoblast原粒细胞原粒细胞 早幼粒细胞早幼粒细胞 中幼粒细胞中幼粒细胞 晚幼粒细胞晚幼粒细胞 杆状核杆状核 分叶核分叶核myeloblast promyelocyte myelocyte metamyelocyte stab segmentedmyeloblast promye
5、locyte myelocyte metamyelocyte stab segmented 嗜酸性嗜酸性 嗜碱性嗜碱性原单核细胞原单核细胞 幼单核幼单核 单核细胞单核细胞原巨核细胞原巨核细胞 幼巨核细胞幼巨核细胞 颗粒型巨核细胞颗粒型巨核细胞 产血小板型巨核细胞产血小板型巨核细胞 血小板血小板原淋巴细胞原淋巴细胞 幼淋巴细胞幼淋巴细胞 淋巴细胞淋巴细胞第四页，本课件共有28页第五页，本课件共有28页Indications of bone marrow examinationDiagnose hematologic diseases -Definitive diagnosis-Definitiv
6、e diagnosis：leukemialeukemia，multiple myeloma(MM)multiple myeloma(MM)-Helpful diagnosis-Helpful diagnosis：idiopathic idiopathic thrombocytopenic purpura(ITP)thrombocytopenic purpura(ITP)Diagnose non-hematologic diseases -Metabolic disordersMetabolic disorders：Gauchers diseaseGauchers disease，Niemann
7、-Pick diseaseNiemann-Pick disease -Metastasis cancer-Metastasis cancer Differential diagnosis of unexplained fever，enlarged liver，enlarged spleen etc.第六页，本课件共有28页Special considerationContraindication：severe bleeding disorders，for example hemophilia 第七页，本课件共有28页Specimens collectionMarrow aspirationMa
8、rrow biopsy第八页，本课件共有28页Steps of bone marrow examinationBME under low power BME on oil lens第九页，本课件共有28页BME under low powerAssesment the degrees of marrow hyperplasiaCount the number of megakaryocytes Observe abnormal cells 第十页，本课件共有28页The degree of marrow hyperplasianucleated cells:erythrocytes ratio
9、 第十一页，本课件共有28页Active proliferationN:E 1:20 第十二页，本课件共有28页Marked hyperplasiaN:E 1:10 第十三页，本课件共有28页Extreme hyperplasiaN:E 1:1 第十四页，本课件共有28页HypoplasiaN:E 1:50 第十五页，本课件共有28页Marked hypoplasiaN:E 1:200 第十六页，本课件共有28页Count the megakaryocytes第十七页，本课件共有28页BME on oil lensMarrow differential count of 200 nucleat
10、ed cells Morphologic examination of marrow cells 第十八页，本课件共有28页Oil immersionCount the percentage of variouse cell types M:E ratio：the percentage of myeloid cells divided by the percentage of erythroide cells第十九页，本课件共有28页Bone marrow report and evaluation 第二十页，本课件共有28页Degrees of marrow hyperplasiaNucle
11、ated cells:Erythrocytes 1:20 DegreesDegrees N:E CausesN:E Causes extreme hyperplasia 1:1 leukemia extreme hyperplasia 1:1 leukemia marked hyperplasia 1:10 leukemia,hyperplastic anemia marked hyperplasia 1:10 leukemia,hyperplastic anemia active proliferation 1:20 normal bone marrow,anemia active prol
12、iferation 1:20 normal bone marrow,anemia hypoplasia 1:50 aplastic anemia(chronic)hypoplasia 1:50 aplastic anemia(chronic)marked hypoplasia 1:200 aplastic anemia(acute)marked hypoplasia 1:200 aplastic anemia(acute)第二十一页，本课件共有28页M:E ratioMyeloid series:Erythroid series 24:1 M:E Myeloid series Erythroi
13、d series CausesM:E Myeloid series Erythroid series Causes 24:1 N N normal bone marrow 24:1 N N normal bone marrow MM,ITP MM,ITP erythroleukemia erythroleukemia aplastic anemia(AA)aplastic anemia(AA)5:1 5:1 N AML or CML N AML or CML N N pure red cell aplasia(PRCA)pure red cell aplasia(PRCA)2:1 2:1 N
14、agranulocytosis N agranulocytosis N N hyperplastic anemia hyperplastic anemiaN=normal N=normal =increase =increase =decrease=decrease第二十二页，本课件共有28页Myeloid series 5060%of nucleated cells cell type range myeloblasts 1%promyelocytes 5%myelocytes 15%metamyelocytes 15%第二十三页，本课件共有28页Erythroid series 20%of
15、 nucleated cells cell type range normoblasts 1%basophilic normoblasts 5%polychromatic normoblasts 10%orthothromatic normoblasts 10%第二十四页，本课件共有28页Others seriesLymphocytes：20%of nucleated cellsmonocytes：4%of nucleated cellsPlasma cells：2%of nucleated cellsMegakaryocytes：other cells or parasites：第二十五页，本课件共有28页Peripheral blood smearWBCs differential countMorphologic examination of RBCsPlatelets 第二十六页，本课件共有28页Make a diagnosisDefinitive diagnosisSupportive diagnosisDescriptive diagnosis第二十七页，本课件共有28页Review Indications and contraindicationSteps of BMEEvaluation 第二十八页，本课件共有28页