More Related Content Similar to bone marrow.pptx Similar to bone marrow.pptx (20) bone marrow.pptx1. BONE MARROW BIOPSY IN
HEMATOLOGICAL MALIGNANCIES
DR SHIVAM SUBUDHI
MODERATOR-DR RANJAN KUMAR MALLICK
2. INTRODUCTION
Bone marrow examination helps in diagnosis and management of
haematological diseases.
Complete marrow assessment entails two separate investigation
Bone marrow aspiration-
• Cell morphology
• Differential count
Bone marrow biopsy-
• Cellularity
• Fibrosis
• Infiltrative disease
3. Indications of biopsy
To accurately assess marrow cellularity
Suspected focal lesions
To diagnose aplastic anemia, hypoplastic MDS, hypoplastic
acute leukemia
Investigation and prognostication of MPN
Diagnosis and staging of Hodgkins, non hodgkins
lymphoma,mets
Unexplained leucoerythroblastic blood picture
PUO
4. Multiple myeloma
Primary amyloidosis
For IHC studies
Stromal changes
• Fibrosis
• Necrosis
• Gelatinous marrow transformation
8. Normal topography
Myeloid- paratrabecular, mature cells towards centre
Erythroid –centre in colonies
Megakaryocytes- centre around sinusoids
Lymphoid precursers- periarteriolar region
Stroma- fat cell, fibroblast, reticulin fibres
13. AML M2
Most frequent cytogenetic abnormality- t(8;21)
Blasts 20- 89% of non erythroid MNCs
Maturing component >10%
14. AML M3
Blast may be <20%
Molecular – PML RARA /t(15;17)
2 types – hypergranular variant, microgranular variant
15. AML M4
Blast >20%
Monocytic component> 20% of non erythroid MNCs
Monocytes in blood>5x103 μl
17. AML M5
Extramedullary infiltration into skin, gum, meninges, lungs
AML M5a- monoblast >80% of monocytic component
AML M5b- monoblast <80%
Acute monocytic leukemia- NPM1 mutation
19. AML M6
3-4 % of AML
Associated with profound anemia
3 sub types
BMA PAS BMB
20. AML M7
Dry tap / diluted marrow aspirate
Megakaryoblastic hyperplasia with extensive fibrosis
Megakaryocytic cells seen in all stages
Associated with t (1;22), down syndrome
23. ALL
Sub types of ALL(FAB)-
L1- small homogenous blasts
L2- large heterogenous blasts
L3 – large homogenous blasts
BMA ALL L1 BMA ALL L2
36. MDS RS SLD MDS RS MLD
PS
BMA PERLS’ STAIN
BMA BMA
41. MPN WHO2016
1. CML, BCR-ABL1 positive
2. CNL
3. PV
4. PMF
5. ET
6. Chronic eosinophilic leukemia, NOS
7. MPN , unclassifiable
8. Mastocytosis
42. CML
chronic phase
PBS- TLC (30-500x103/μl), myelocytic bulge,absolute
basophilia, thrombocytosis
NAP score (0-20)
BM-hypercellular, M:E ratio elevated, blast<5%,
megakaryocyte hyperplasia with dwarf forms seen
BMA
44. CML
Accelerated phase
Blasts 10-19%
Persistent thrombocytosis or thrombocytopenia
Basophilia >20%
Blast crisis
Blast>20%
Anemia and thrombocytopenia
25% cases- lymphoblastic
Accelerated phase
Blast crisis
54. Non Hodgkin’s lymphoma
Patterns of marrow involvement
Packed / diffuse
Nodular
Paratrabecular
Interstitial
Mixed
Intra sinusoidal
56. Mantle cell lymphoma
Difffuse marrow invovment
Paratrabecular arrangement
Variants- blastoid, lymphocytic, pleomorphic
57. Hairy cell leukemia
PBS- pancytopenia ,hair like projections on lymphoid cells
TRAP positive
Splenomegaly
BRAFV600E mutation
BM- dry tap, focal/ interstitial / diffuse replacement of
marrow by hairy cells
60. Hodgkin’s lymphoma
Bm involvement – stage IV
Rarely involves BM
BM- hyper cellular due to myeloid hyperplasia
RS cells
63. SUMMARY
Bone marrow biopsy helps in diagnosis, staging
and predicting prognosis of different
hematological malignancies
It should be ideally reported along with bone
marrow aspiration and peripheral smear
Clinical history, laboratory investigations ,
imaging information, all should be taken into
consideration before any diagnosis