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MLAB 1415- Hematology Keri Brophy-Martinez Chapter 35: Bone Marrow.

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Presentation on theme: "MLAB 1415- Hematology Keri Brophy-Martinez Chapter 35: Bone Marrow."— Presentation transcript:

1 MLAB Hematology Keri Brophy-Martinez Chapter 35: Bone Marrow

2 Bone marrow differentiates into myeloid, erythroid and lymphoid cell lineages under the influence of cytokines or growth factors. Bone marrow differentiates into myeloid, erythroid and lymphoid cell lineages under the influence of cytokines or growth factors. Function: supply mature hematopoietic cells into peripheral blood and respond to demands Function: supply mature hematopoietic cells into peripheral blood and respond to demands

3 Bone Marrow Highly vascularized loose connective tissue Highly vascularized loose connective tissue Organized around bone vasculature Organized around bone vasculature Located between trabeculae of spongy bone Located between trabeculae of spongy bone Composed of 2 major compartments Composed of 2 major compartments Hematopoietic Hematopoietic Vascular Vascular

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5 Indications for BM Evaluation Hematological and nonhematological disorders often requires BM evaluation for Hematological and nonhematological disorders often requires BM evaluation for Diagnosing Diagnosing Managing Managing Making prognoses Making prognoses Following up on disorders Following up on disorders Bone marrow should be evaluated together with Bone marrow should be evaluated together with Peripheral blood counts Peripheral blood counts Peripheral blood smear Peripheral blood smear

6 Indication for Bone Marrow Studies Hematologic diseases Hematologic diseases Anemia, erythrocytosis, polycythemia Anemia, erythrocytosis, polycythemia Leukopenia and unexplained leukocytosis Leukopenia and unexplained leukocytosis Appearance of abnormal or immature cells in the peripheral blood circulation Appearance of abnormal or immature cells in the peripheral blood circulation Thrombocytopenia or thrombocytosis Thrombocytopenia or thrombocytosis Systemic disease Systemic disease Solid malignant tumors elsewhere in the body - done at initial diagnosis to determine the degree of tumor spread and to stage the malignancy Solid malignant tumors elsewhere in the body - done at initial diagnosis to determine the degree of tumor spread and to stage the malignancy Infections known as “fever of unknown origin” (FUO) in which organisms may be within the marrow. Infections known as “fever of unknown origin” (FUO) in which organisms may be within the marrow. Certain histiocytic diseases Certain histiocytic diseases

7 Bone Marrow Procedure Sites of hematopoiesis Sites of hematopoiesis Differ by age Differ by age Certain disease states Certain disease states Red marrow can extend into long bones Red marrow can extend into long bones Cellularity within red marrow decreases with age Cellularity within red marrow decreases with age Adipose tissue replaces hematopietic tissue Adipose tissue replaces hematopietic tissue

8 Bone Marrow Procedure Marrow specimens Marrow specimens After adolescence After adolescence Posterior superior iliac crest Posterior superior iliac crest Occasionally sternum and anterior iliac crest Occasionally sternum and anterior iliac crest < 2 years of age < 2 years of age Anterior tibia Anterior tibia Older children Older children Spines of the lumbar vertebral bodies L1 and L2 Spines of the lumbar vertebral bodies L1 and L2

9 Laboratorian’s role in bone marrow procedure Provide necessary equipment Provide necessary equipment Preparation of the specimen for analysis Preparation of the specimen for analysis Use sterile technique Use sterile technique Make direct smears from the aspirate Make direct smears from the aspirate Make crush smears from the marrow spicules Make crush smears from the marrow spicules Place extra aspirate into anticoagulated tubes Place extra aspirate into anticoagulated tubes Performance of the preliminary exam and processing Performance of the preliminary exam and processing

10 Bone Marrow Equipment Bone marrow aspirates and biopsies Bone marrow aspirates and biopsies Obtained using disposable needles Obtained using disposable needles Jamshidi trephine needle (8 or 11 gauge) Jamshidi trephine needle (8 or 11 gauge) Sterile technique always used Sterile technique always used

11 Processing the specimen in the lab Place EDTA specimen (liquid aspirate) in Wintrobe tube and centrifuge at low speed. Place EDTA specimen (liquid aspirate) in Wintrobe tube and centrifuge at low speed. Measure layers formed by centrifugation Measure layers formed by centrifugation FPV - fat and perivascular FPV - fat and perivascular used for iron stain used for iron stain Plasma Plasma Buffy coat (myeloid:erythroid cells- M:E) Buffy coat (myeloid:erythroid cells- M:E) Normal is 4:1. M:E is the ratio between all granulocytes and their precursors and all nucleated red cell precursors. RBC’s RBC’s

12 Processing the specimen in the lab Prepare and stain ME smears. Prepare and stain ME smears. Deliver clot remaining in syringe and biopsy to histology for processing. Deliver clot remaining in syringe and biopsy to histology for processing. Deliver other specimens obtained such as viral, fungal or routine culture specimens to microbiology. Deliver other specimens obtained such as viral, fungal or routine culture specimens to microbiology. Complete paperwork and package specimens to be sent out to reference lab Complete paperwork and package specimens to be sent out to reference lab

13 Information derived from specimens Direct smear from syringe tip - evaluation of cellular morphology with Wright’s stain Direct smear from syringe tip - evaluation of cellular morphology with Wright’s stain Particle (crush) smear - evaluation of cellularity and the relationship of cells to each other Particle (crush) smear - evaluation of cellularity and the relationship of cells to each other M:E smear - evaluation of hematopoietic cells and M:E ratio M:E smear - evaluation of hematopoietic cells and M:E ratio Biopsy Biopsy If marrow cannot be aspirated (“dry tap”), this is the only specimen for examination If marrow cannot be aspirated (“dry tap”), this is the only specimen for examination Examination for malignancy for clinical staging of lymphomas and cancers Examination for malignancy for clinical staging of lymphomas and cancers Examination of the architecture of the bone marrow and the cells in their natural relationship to each other Examination of the architecture of the bone marrow and the cells in their natural relationship to each other Trephine imprint (touch prep) - examination of cells with Wright’s stain; may be the only source to study cellular detail if an aspirate is not obtained Trephine imprint (touch prep) - examination of cells with Wright’s stain; may be the only source to study cellular detail if an aspirate is not obtained

14 References Harmening, D. M. (2009). Clinical Hematology and Fundamentals of hemostasis (5th ed.). Philadelphia, PA: F.A. Davis Company. Harmening, D. M. (2009). Clinical Hematology and Fundamentals of hemostasis (5th ed.). Philadelphia, PA: F.A. Davis Company. McKenzie, S. B. (2010). Clinical Laboratory Hematology (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. McKenzie, S. B. (2010). Clinical Laboratory Hematology (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. osteoporosis.423.en.html osteoporosis.423.en.html osteoporosis.423.en.html osteoporosis.423.en.html amshidi-Bone-Marrow-Aspiration-Needles.html amshidi-Bone-Marrow-Aspiration-Needles.html


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