Microsoft power point_-_bm_exam

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Microsoft power point_-_bm_exam

  1. 1. Bone Marrow Examination Nungruthai Nimnuch School of Allied Health Sciences 1 Naresuan University Phayao
  2. 2. (Bone marrow) F spongy tissue F F F F F F F 2
  3. 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. 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. 5
  6. 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. 7. Bone marrow aspiration 7
  8. 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. 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. 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. 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. 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. 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. 14. Diluted specimen F F F F F F F low power field red blood cell F fat cell megakaryocyte 14
  15. 15. 1.4 Megakaryocyte megakaryocyte F F F 1-15 cells/LPF Megakaryocyte 15
  16. 16. F F F F F F 16
  17. 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. 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. 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. 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. 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. 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. 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. 24. 1.8 Blast cells blast cell F F 3% nucleated cell blast cell > 30% leukemia? Pronormoblast Lymphoblast Myeloblast Monoblast 24
  25. 25. 1.9 Metastatic cells F (metastasis) Metastatic cells 25 http://www.healthsystem.virginia.edu/internet/hematology/hessidb/Rare-bone-marrow-findings.cfm
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