Bone Marrow Examination

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• Bone Marrow Examination
• (BME)

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contents

• The developmental sequence of marrow cells
• Indications and contraindications of bone marrow
  examination
• Specimens collection
• Steps of bone marrow examination
• Report and evaluation of bone marrow examination

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The developmental sequence of marrow cells

• Bone Marrow
  Blood
• Stem Cells Progenitor cells
  Mature cells
• Erythroid
  Erythrocytes
• Myelomonocytic
  Neutrophils/monocytes
• Myeloid Eosinophil
  Eosinophils
• T stem cells Basophil
  Basophils
• S Megakaryocytes
  Platelets
• C Lymphoid Lymphoid
  Lymphocytes
• stem cells

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Development of progenitor cells

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• normoblast basophilic polychromatic
  orthochromatic erythrocyte
• normoblast normoblast
  normoblast
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• myeloblast promyelocyte myelocyte
  metamyelocyte stab segmented
• 
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Indications of bone marrow examination

• Diagnose hematologic diseases
• -Definitive diagnosis leukemia,
• 
  multiple myeloma(MM)
• -Helpful diagnosis idiopathic
• 
  thrombocytopenic purpura(ITP)
• Diagnose non-hematologic diseases
• -Metabolic disordersGauchers disease,
• 
  Niemann-Pick disease
• -Metastasis cancer
• Differential diagnosis of unexplained
  fever,enlarged liver,enlarged spleen etc.

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Special consideration

• Contraindicationsevere bleeding disorders,for
  example hemophilia

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Specimens collection

• Marrow aspiration
• Marrow biopsy

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Steps of bone marrow examination

• BME under low power
• BME on oil lens

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BME under low power

• Assesment the degrees of marrow hyperplasia
• Count the number of megakaryocytes
• Observe abnormal cells

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The degree of marrow hyperplasia

• nucleated cells
  erythrocytes
• ratio

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Active proliferation

• NE 120

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Marked hyperplasia

• NE 110

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Extreme hyperplasia

• NE 11

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Hypoplasia

• NE 150

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Marked hypoplasia

• NE 1200

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Count the megakaryocytes
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BME on oil lens

• Marrow differential count of 200 nucleated cells
• Morphologic examination of marrow cells

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Oil immersion

• Count the percentage of variouse cell types
• ME ratiothe percentage of myeloid
• cells divided by the percentage of
• erythroide cells

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Bone marrow report and evaluation

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Degrees of marrow hyperplasia

• Nucleated cells Erythrocytes 120
• Degrees NE
  Causes
  -----------------------------
• extreme hyperplasia 11
  leukemia
• marked hyperplasia 110
  leukemia, hyperplastic anemia
• active proliferation 120
  normal bone marrow, anemia
• hypoplasia 150
  aplastic anemia(chronic)
• marked hypoplasia 1200
  aplastic anemia(acute)
• 
  

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ME ratio

• Myeloid seriesErythroid series 241
• ------------------------------
• ME Myeloid series Erythroid series
  Causes
• ------------------------------
• 241 N
  N normal bone marrow
  
• 
  MM , ITP
• ?
  ? erythroleukemia
• ?
  ? aplastic anemia(AA)
• gt51 ? N
  AML or CML
• N
  ? pure red cell aplasia(PRCA)
• lt21 ? N
  agranulocytosis
• N
  ? hyperplastic anemia
• Nnormal ?increase ?decrease

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Myeloid series

• 5060 of nucleated cells
• cell type range
• myeloblasts lt1
• promyelocytes lt5
• myelocytes lt15
• metamyelocytes lt15

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Erythroid series

• 20 of nucleated cells
• cell type
  range
• normoblasts lt1
• basophilic normoblasts lt5
• polychromatic normoblasts lt10
• orthothromatic normoblasts lt10

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Others series

• Lymphocytes 20 of nucleated cells
• monocytes lt4 of nucleated cells
• Plasma cells lt2 of nucleated cells
• Megakaryocytes
• other cells or parasites

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Peripheral blood smear

• WBCs differential count
• Morphologic examination of RBCs
• Platelets

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Make a diagnosis

• Definitive diagnosis
• Supportive diagnosis
• Descriptive diagnosis

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Review

• Indications and contraindication
• Steps of BME
• Evaluation