Bone marrow biopsy and aspiration provide qualitative and quantitative assessment of hematopoiesis. It can help make diagnoses of blood disorders like anemia and help stage diseases like lymphoma. The bone marrow has a structured organization with hematopoietic and stromal components. Biopsy and aspiration samples are analyzed microscopically after staining to evaluate cellularity, maturation of blood cell lineages, iron stores, and detect any abnormalities. This procedure helps diagnose conditions affecting the bone marrow including infections, storage diseases, and cancers.
technique of preparing imprint smear# comparision with frozen sections# application and its role in thyroid ,paathyroid,breast,skin,head and neck and mucinous tumors# advantages and limitations
This presentation in mainly focused of understanding of automation and its utility in cytopathology. It will be very usefull for postgraduate in pathology, cytopathologist and cytotechnicians.
technique of preparing imprint smear# comparision with frozen sections# application and its role in thyroid ,paathyroid,breast,skin,head and neck and mucinous tumors# advantages and limitations
This presentation in mainly focused of understanding of automation and its utility in cytopathology. It will be very usefull for postgraduate in pathology, cytopathologist and cytotechnicians.
CSF:
Derived through ultrafilteration and secretion through choroid plexus, produced at the rate of 500 ml/day.
Provides physical support, collects wastes, circulates nutrients and lubricates the CNS.
Normal CSF volumes:
In Adults: 90 - 150 ml
In Neonates: 10 - 60 ml
Total CSF volume is replaced every 5-7 hours.
COLLECTION
Lumbar puncture, Cisternal puncture, Lateral cervical puncture, Shunts and cannulas
Opening pressure – 90-180 mm H2O
Approximately 15-20 cc fluid collected
LAB
REQUIRED
Opening CSF pressure
Total cell count
Differential cell count
Glucose
Total protein
OPTIONAL
Cultures, Gram stain, AFB, Fungal and bacterial
antigens, Enzymes, PCR, Cytology, Electrophoresis,
VDRL, D-Dimers
Cervical cytology was introduced by George
Papanicolaou into clinical practice in 1940. In 1945,
the Papanicolaou smear received the endorsement of
the American cancer society as an effective method
for the prevention of cervical cancer .
www.drvikramsaraswat.co.in
www.drsaraswatpathlabs.com
CSF:
Derived through ultrafilteration and secretion through choroid plexus, produced at the rate of 500 ml/day.
Provides physical support, collects wastes, circulates nutrients and lubricates the CNS.
Normal CSF volumes:
In Adults: 90 - 150 ml
In Neonates: 10 - 60 ml
Total CSF volume is replaced every 5-7 hours.
COLLECTION
Lumbar puncture, Cisternal puncture, Lateral cervical puncture, Shunts and cannulas
Opening pressure – 90-180 mm H2O
Approximately 15-20 cc fluid collected
LAB
REQUIRED
Opening CSF pressure
Total cell count
Differential cell count
Glucose
Total protein
OPTIONAL
Cultures, Gram stain, AFB, Fungal and bacterial
antigens, Enzymes, PCR, Cytology, Electrophoresis,
VDRL, D-Dimers
Cervical cytology was introduced by George
Papanicolaou into clinical practice in 1940. In 1945,
the Papanicolaou smear received the endorsement of
the American cancer society as an effective method
for the prevention of cervical cancer .
www.drvikramsaraswat.co.in
www.drsaraswatpathlabs.com
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Bone marrow biopsy and interpretation
1. BONE MARROW BIOPSY AND ASPIRATION
MODERATOR: Dr. C.J. PRAKASH
PRESENTER: Dr. SPOORTHY
2. INTRODUCTION
Bone Marrow Examination provides a Semi-Quantitative
and Qualitative assessment of the state of Haemopoiesis
Biopsy of Bone Marrow is an indispensable adjunct to the
study of diseases of blood
It may be the only way a correct diagnosis can be made
3. HISTORY
1905 Pianese
Trephine bx in an
infant with
Leishmaniasis.
1909 Pianese
Tibia & femur marrow
aspiration with
attached syringe.
1923 Seyfaith
Surgical trephine to obtain marrow
from ribs & sternum.But there was
excessive bleeding.
1927 Airinkin
Eliminated trephine complication
by using short lumbar needle.
1945 Vandenberg
First obtained marrow
from iliac crest.
Used posterior Iliac
4. STRUCTURE OF BONE
Bone
Cortex:
Strong layer of Compact bone
Gives bone strength
Made of Lamellar bone
contains well organised Haversian
canals
Cortex
Medulla
5. MEDULLA
Made up of Cancellous bone or Trabeculae
Trabeculae and inner surface of cortex are lined by
Endosteal cells
Osteoblasts
Osteocytes
Osteoclasts
6.
7. PARENCHYMA:
Haematopoiteic stem cells and Precursors
Mature cells of Erythroid, Myeloid and Megakaryocytic cells
STROMA:
Fat cells, Histiocytes,Fibroblasts,Blood vessels, Intercellular
Matrix
8. BONE MARROW
Normal Bone Marrow
Red Marrow: Haematopoietic cells
Yellow Marrow : Adipose tissue
Red bone marrow consists of 4% of Total bone marrow
The weight of total bone marrow ranges from- 1600-
3700gm
Red Marrow
Yellow Marrow
9.
10. Children: most bones contain Haematopoietic cells
Adults- 1. Skull
2. Sternum
3. Scapulae
4. Ribs
5. Pelvic Bones
6. Proximal ends of long bones
11. PRINCIPLE
The Morphological assessment of aspirated or core biopsy
specimens is based on these principles
1. Bone Marrow has an organised structure
2. In normal health bone marrow cells display distinct
numerical and spatial relationships with each other
3. Individual marrow cells have distinct cytological
appearances
4. This reflects the lineage and stage of maturation
5. Each or all of these may be specifically disordered in a
disease
12.
13. INDICATIONS
ANEMIA
1. MICROCYTIC ANEMIA:
Evaluation of Iron stores and Sideroblasts: allows categorisation of
anaemia
2. MACROCYTIC ANEMIA:
To confirm whether the process is Megaloblastic or not
3. NORMOCYTIC ANEMIA: without an increase in retic count
For quantitative or qualitative abnormalities of Erythropoiesis
14. DIAGNOSIS AND STAGING OF:
Non hodgkin’s lymphoma
Hodgkin’s lymphoma
Malignancy
Metastatic carcinoma
Small round cell tumors of childhood
STROMAL CHANGES:
Fibrosis
Necrosis
Gelatinous marrow transformation
16. NEUTROPENIA,
THROMBOCYTOPENIA,PANCYTOPENIA:
To assess the presence and normality of precursor cells
To assess the probability of decreased production, impaired
maturation or increased destruction
CYTOPENIA
To reveal the presence of leukaemia or another
Haematological neoplasia
17. • Unexplained leukoerythroblastic picture.
• In suspected cases of multiple myeloma and serum paraproteins.
• Pyrexia of unknown origin
• Focal lesions –Metastasis, Granuloma
• Amyloidosis
• Metabolic bone diseases
• To assess the mineralisation front and appositional growth after
tetracycline labelling
18. CONTRAINDICATIONS
BIOPSY IN COAGULOPATHIES
(For aspiration : factor replacement therapy prior to procedure and
observation should be done for next 24-48 hrs.)
STERNAL ASPIRATE - OSTEOPOROSIS AND CHILDREN
19. SITES
1. Sternum
2. Anterior Iliac spine
3. Posterior Iliac spine: 1.overlies a large marrow space
2. Larger samples can be obtained
4.Upper end of Tibia- Children < 1year old
20.
21. STERNUM
Usual sites:
1. Manubrium
2. 1st and 2nd parts of Body of Sternum
Precaution: Appropriate Guard is supposed to be used
Danger of perforating the Inner cortical layer and Damaging
the underlying large blood vessels
Right atrium
22. Klima Sternal Needle Salah Bone Marrow Aspiration
Watherfield Iliac Crest Bone Aspiration
Modern Jamshidi Needle
23.
24.
25. PROCEDURE
Consent: A written consent should be taken from
patient.
• An appropriate clinical history should accompany the
bone marrow, as they relate to possible findings within
the bone marrow examination.
26. It is useful to know relevant laboratory data such as
Iron studies, Folate or Vitamin B-12 studies,
transfusion therapy, or history of chemotherapy.
The physician’s clinical impression should be included
on the form.
Lignocaine sensitivity test should be done.
29. ASPIRATION BIOPSY
Better cytological detail
Topographical details, cellularity
and infiltration
More range for Cytochemical
stains, Flow cytometry. IHC
Less Range
Ideal for Cytogenics and Molecular
Genetics
Can be used for both
Dry tap in fibrosis Essential for diagnosis in Dry tap
Less painful More painful
30. ASPIRATE
Smears should be made without delay at the bedside
Remaining material should be delivered into a bottle
containing EDTA
Preservative free Heparin should be used if
Immunophenotyping or Cytogenetic studies are needed.
Some material can be fixed in Fixative rather than
anticoagulant for preparing histological sections
Some films should be fixed in Absolute Methanol for
subsequent staining by Romanowsky Method or Perl’s stain
31. • Appropriate amounts of
anticoagulant for the volume
of marrow to be
anticoagulated are used
• Gross excess of
anticoagulant: masses of
pink-staining amorphous
material may be seen
• Clumping of some
erythroblasts and
reticulocytes may be seen
32. CENTRIFUGATION
Centrifugation can be used to concentrate the Marrow cells
To assess the relative proportion of Marrow cells,
Peripheral blood and Fat in Aspirated material
Useful : 1. Poorly cellular sample
2. Abnormal cells are present in small numbers
34. DIRECT FILMS
A drop of marrow is placed on a slide a short distance away
from one end
A film 3-5cm is made with a spreader, not wider than 2cm
Dragging the particles behind them but not squashing them.
A trail of cells is left behind each particle
35.
36.
37. CRUSH PREPARATIONS
Marrow particles in a small drop
of aspirate is placed on a slide at
one end
Another slide is placed on the first
Slight pressure is exerted to crush
the particles and slides are
separated by pulling them apart in
a direction parallel to their
surfaces
38. IMPRINTS
Marrow particles can also be used for preparation of imprints
One or more particles are picked up capillary pipet
Transferred immediately to a slide and made to stick to it by a
gentle smearing motion.
The slide is air dried rapidly by waving, then it is stained
45. STAINING OF SECTIONS
Bone marrow sections are routinely stained with
Haematoxylin and Eosin
It is excellent for demonstrating the cellularity and pattern of
the Marrow.
This reveals the pathological changes such as presence of
Granuloma or Carcinoma cells
Haematopoietic cells may be more easily identified in a
Romanowsky stained preparation
46. Other stains that are usually done are:
1. PERL’S STAIN - IRON
2. SILVER IMPREGNATION METHOD -
RETICULIN
Both Plastic and Paraffin embedded specimens
can be used for IHC
49. CELLULARITY
Expressed as a ratio of volume of Hematopoietic cells to the
total volume of marrow spaces
It is best judged by Histological sections of biopsy or aspirated
particles
Can also be estimated from the particles present in the Marrow
films
Done my comparing the areas occupied by Fat spaces and By
Nucleated cells
Also by the density of Nucleated cells in the Tail or fallout of
particles
50. Cellularity varies with the age of the subject and the site
50 years of age : Vertebrae : 75%
Sternum : 60%
Iliac crest : 50%
Rib : 30%
If the percentage is increased for patients age: Hypercellular
If the percentage is decreased for patients age : Hypocellular
52. SYSTEMATIC SCHEME FOR EXAMINATION OF BONE MARROW ASPIRATE
LOW POWER:
Determine Cellularity
Identify Megakaryocytes
Note Morphology and Maturation Sequence
Look for clumps of abnormal cells: METASTATIC TUMOUR
Identify Macrophages
53.
54. HIGHER POWER:
Identify all stages of maturation of Myeloid and Erythroid
cells
Determine the Myeloid:Erythroid ratio
Perform Differential count: Erythroid,
Myeloid,Lymphoid,Plasma cells and Others
Look for areas of bone marrow Necrosis
Assess the Iron content of the Macrophages
Look for Iron granules in Erythroid cells: Perl’s stain
56. MYELOID CELLS MEGAKARYOCYTES
ERYTHROID CELLS
STROMA
Para Trabecular
Mature cells
Centre around Sinusoids
Centre in Colonies Fat cells
Reticulin Fibres
Fibroblasts
Macrophages
72. PERL’S STAIN
Also called Prussian blue stain
Demonstrates Haemosiderin in Bone marrow Macrophages
and Erythroblasts
Hence it allows the assessment of Iron
Reticulo-Endothelial cells
Developing Erythroblasts
73. REQUIREMENTS
Assessment of storage iron requires that an adequate
number of fragments are obtained
A Minimum of 7 Bone marrow fragments in one or more
bone marrow films are needed to be examined.
To state that the bone marrow Iron is reasonably absent
A Bone marrow film or Crush preparation will contain both
Intracellular and Extra cellular Iron
It is basic to count only Intra cellular iron
74. ASSESSMENT
Iron stores may be assessed as: NORMAL, DECREASED,
INCREASED
May be graded as +1 - +6
Where +1 - +3 is regarded as Normal
A Proportion of Normal Erythroblasts have few(1-5) fine
iron containing granules randomly distributed in the
cytoplasm
These are called SIDEROBLASTS
75. GRADING OF IRON STORES
0 NO STAINABLE IRON
1+
SMALL IRON PARTICLES JUST VISIBLE IN
RETICULUM CELLS UNDER OIL IMMERSION
2+
SMALL IRON PARTICLES VISIBLE IN
RETICULUM CELLS UNDER LOW POWER
3+
NUMEROUS SMALL PARTICLES IN
RETICULUM CELLS
4+
LARGER PARTICLES WITH A TENDENCY TO
AGGREGATE INTO CLUMPS
5+ DENSE LARGER CLUMPS
6+
VERY LARGE CLUMPS AND EXTRA
CELLULAR IRON
79. RETUCULIN STAIN
Histological sections can be stained by Silver Impregnation
Method for Reticulin
For Collagen- Trichrome stain
Reticulin is closely concentrated more around the blood
vessels and bony trabeculae
Hence these areas should be disregarded while grading
80. BAUERMEISTER GRADING
0
No Reticulin Fibres
Demonstrable
1
Occasional fine Individual fibres
and foci of a fine fibre network
2
Fine fibre network throughout.
No coarse fibres
3
Diffuse fibre network with
scattered thick coarse fibres but
no mature collagen
4
Diffuse often coarse fibre
network with areas of
collagenization
81. Many normal subjects may have Reticulin grade 0-
+1
Some may even have a grade of +2
There is a tendency of reticulin to be deposited
more in Iliac crest or than in the Sternum
84. OTHER STAINS USED
Chloroacetate esterase
Identification of Granulocyte
differentiation and Mast cells
PAS
Staining of complex
carbohydrates, identification of
fungi
Toulidine blue Identification of Mast cells
Congo Red Identification of Amyloid
Z-N stain Identification of Mycobacteria
92. SUPPLEMENTARY
INVESTIGATIONS
1. Immunohistochemistry- for demonstration of antigens in
biopsy
Ex.- CD 34, CD 45, Lysozyme, MPO, CD 68, CEA etc.
2. Cytogenetic analysis- for chromosomal rearrangements
3. Molecular genetics- by PCR, RTPCR
4. FISH