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Hematopoietic System- 1 Bone Marrow Hematopoiesis Linda F. Cunningham, MD January 2, 2003.

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Presentation on theme: "Hematopoietic System- 1 Bone Marrow Hematopoiesis Linda F. Cunningham, MD January 2, 2003."— Presentation transcript:

1 Hematopoietic System- 1 Bone Marrow Hematopoiesis Linda F. Cunningham, MD January 2, 2003

2 Hematopoietic System Bone Marrow Hematopoietic active marrow with stem cells, progenitor cells, and developing erythroblasts, myeloblasts, and megakaryoblasts (red marrow)Hematopoietic active marrow with stem cells, progenitor cells, and developing erythroblasts, myeloblasts, and megakaryoblasts (red marrow) Adipose cells, various with age and activity (yellow marrow)Adipose cells, various with age and activity (yellow marrow) Marrow sinuses and capillary networkMarrow sinuses and capillary network

3 Slide ASCP Bone Marrow 3:ASCP Bone Marrow 3: Histology 6.2: Trabecular bone with hematopoietic tissue and fatHistology 6.2: Trabecular bone with hematopoietic tissue and fat Rodak 7 Bone Marrow with hematopoietic tissue, capillaries, and fatRodak 7 Bone Marrow with hematopoietic tissue, capillaries, and fat Rodak #76 Core Biopsy shows 50 % fat and 50 % hematopoietic tissue Rodak #76 Core Biopsy shows 50 % fat and 50 % hematopoietic tissue

4 Hematopoietic System Bone Marrow Amount of red marrow varies with age of patientAmount of red marrow varies with age of patient –Childhood: Red marrow is 100% of BM and present in virtually every bone –Adults: Red marrow is ~50% of BM and present in sternum, ribs, pelvis, and skull –~70 years: Red marrow reduced to ~ 30% of the BM

5 Slides Slide -Changes in site for Hematopoiesis with ageSlide -Changes in site for Hematopoiesis with age Bone Marrow in Skeleton Rodak 4Bone Marrow in Skeleton Rodak 4 Bone Marrow Biopsy Site Rodak 66Bone Marrow Biopsy Site Rodak 66 ASCP Bone Marrow 13: Cellular, 5 y.oASCP Bone Marrow 13: Cellular, 5 y.o 14: Less Cellular 35 y.o.14: Less Cellular 35 y.o. 30: Hypocellular, aplastic anemia30: Hypocellular, aplastic anemia

6 Clinical Evaluation Tests of Bone Marrow Function Small amounts of myeloid tissue (myelos=marrow) is removed from bone cavity and examined under the microscope- Bone marrow aspiration Bone marrow biopsy

7 Hematopoietic System Bone Marrow Bone Marrow Core Biopsy Cellularity and the architecture Bone Marrow Aspiration Cytology and maturation

8 Slides Rodak 76: Core biopsy; Cellularity 50%Rodak 76: Core biopsy; Cellularity 50% ASCP BM 237: AIDS granulomaASCP BM 237: AIDS granuloma #204: Spindle cells#204: Spindle cells Robbins #338 HypoplasticRobbins #338 Hypoplastic Pathology HyperplasticPathology Hyperplastic Pathology Hyperplastic due to acute leukemiaPathology Hyperplastic due to acute leukemia

9 Slides Bone Marrow AspirationBone Marrow Aspiration –Rodak 67 Aspirate smear –Rodak # 68 Myeloblast, promyelocyte, myelocyte, and lymphocyte –Rodak #71 Bands and segs

10 Hematopoiesis Key Terms Stem cellsStem cells Precursors cells (Blasts)Precursors cells (Blasts) Terms for each stage in the morphologic differentiationTerms for each stage in the morphologic differentiation

11 Hematopoiesis ProerythroblastProerythroblast Basophilic erythroblastBasophilic erythroblast Polychromatophilic erythroblastPolychromatophilic erythroblast Orthrochromatophic erythroblastOrthrochromatophic erythroblast ReticulocyteReticulocyte ErythrocyteErythrocyte Myeloblast Promyelocyte Myelocyte Metamyelocyte Band cell Mature granulocyte (neutrophil, eosinophil, or basophil)

12 Slides RBC MaturationRBC Maturation Harmening1-3Harmening1-3 Histology 6.5Histology 6.5 ASCP 2.6ASCP

13 Slides CAP PolychromasiaCAP Polychromasia CAP Reticulocyte stainCAP Reticulocyte stain

14 Medical Histology RBC Maturation Sequence The red cell maturation sequence and significance of the change in red cell size and cytoplasmic color –Polychromatophilic red blood cells to illustrate newly released red cells –Reticulocytes to illustrate bone marrow response to anemia –Nucleated red blood cells in peripheral blood to illustrated bone marrow stress

15 Slides Diagram of red cell maturation and time sequenceDiagram of red cell maturation and time sequence Normal; red blood cellsNormal; red blood cells CAP PolychromasiaCAP Polychromasia CAP Reticulocyte stainCAP Reticulocyte stain

16 Slides ASCP 4-30 Polychromatophilic RBC with basophilicASCP 4-30 Polychromatophilic RBC with basophilic ASCP 2-17 Reticulocyte stained with methylene blueASCP 2-17 Reticulocyte stained with methylene blue ASCP 2-18 Normal mature RBCASCP 2-18 Normal mature RBC ASCP4-33 and 34 RBC and Rete stainASCP4-33 and 34 RBC and Rete stain CAP: Nucleated red blood cellCAP: Nucleated red blood cell

17 Medical Histology Erythropoiesis Recognize the bone marrow response to anemia Accelerated ErythropoiesisAccelerated Erythropoiesis –Released Reticulocytes Insufficient ErythropoiesisInsufficient Erythropoiesis –Inadequate reticulocytes

18 Medical Histology Bone Marrow and Red Cell Size Recognize the clinical significance of size of red cellsRecognize the clinical significance of size of red cells Recognize the size change with maturationRecognize the size change with maturation Classify anemia based on red cell sizeClassify anemia based on red cell size –Small = Microcytic –Large = Macrocytic –Normal = Normocytic

19 Slides Histology Figure 6-5 StagesHistology Figure 6-5 Stages ASCP 2-06 Pronormoblast and orthroblastASCP 2-06 Pronormoblast and orthroblast ASCP 2-12 Orthro and polychrom ASCP 2-12 Orthro and polychrom ASCP 2-15 Poly, orthro, polychromatophilic RBCASCP 2-15 Poly, orthro, polychromatophilic RBC ASCP 2-14 Orthro losing its nucleus, late polyASCP 2-14 Orthro losing its nucleus, late poly

20 Slides Rodak # 86 Iron DeficiencyRodak # 86 Iron Deficiency ASCP 4-16 Iron DeficiencyASCP 4-16 Iron Deficiency ASCP Macrocytic with LymphocyteASCP Macrocytic with Lymphocyte

21 Hematopoiesis ProerythroblastProerythroblast Basophilic erythroblastBasophilic erythroblast Polychromatophilic erythroblastPolychromatophilic erythroblast Orthrochromatophic erythroblastOrthrochromatophic erythroblast ReticulocyteReticulocyte ErythrocyteErythrocyte Myeloblast Promyelocyte Myelocyte Metamyelocyte Band cell Mature granulocyte (neutrophil, eosinophil, or basophil)

22 Slides Histology 6.8 all stagesHistology 6.8 all stages Harmening 1-17: Blast, promyelocyte, myelocyte, metamyelocyte, band, segmented; eosinophil myelocyte, metamyelocyte, band, and mature eosinophilHarmening 1-17: Blast, promyelocyte, myelocyte, metamyelocyte, band, segmented; eosinophil myelocyte, metamyelocyte, band, and mature eosinophil ASCP 2-22: Myeloblast and promyelocyteASCP 2-22: Myeloblast and promyelocyte ASCP 2-25 Promyelocyte, myelocyte, band, segmented neutrophilASCP 2-25 Promyelocyte, myelocyte, band, segmented neutrophil

23 Medical Histology Neutrophilia and Immature Cells Leukocyte Maturation and Response to Infection produces a left shifted maturation: early cells in the peripheral bloodLeukocyte Maturation and Response to Infection produces a left shifted maturation: early cells in the peripheral blood –Increased numbers of neutrophils leave the bone marrow storage spaces –Increased neutrophil production –Immature forms - bands, metamyelocytes, and even myelocytes leave the bone marrow

24 Slides Leukocytosis with left ShiftLeukocytosis with left Shift

25 Medical Histology Leukocyte Maturation Leukemia and Maturation of Leukocytosis –Acute Leukemia: Immature cells Granulocyte maturation AMLGranulocyte maturation AML Lymphocyte maturation ALLLymphocyte maturation ALL –Chronic Leukemia: Mature cells Granulocyte maturation CMLGranulocyte maturation CML Lymphocyte maturation CLLLymphocyte maturation CLL

26 Slides Saunders # 349 Lack of maturation, monotonous population, acute leukemiaSaunders # 349 Lack of maturation, monotonous population, acute leukemia CAP HE-23 Mature lymphocyte and lymphoblastCAP HE-23 Mature lymphocyte and lymphoblast ASCP 6-10 Maturation of granulocytic cells in CGLASCP 6-10 Maturation of granulocytic cells in CGL

27 Slides Cancer Maturation of granulocytic cellsCancer Maturation of granulocytic cells ASCP 6-40 Maturation of granulocytic cellsASCP 6-40 Maturation of granulocytic cells ASCP 6-45 and 6-46 CLL monotonous populationASCP 6-45 and 6-46 CLL monotonous population CAP HE-25 Normal lymphocyteCAP HE-25 Normal lymphocyte Saunders #353 CLLSaunders #353 CLL

28 Platelet Maturation Platelet fragmentation from megakaryocytes; these differentiated from megakaryoblastsPlatelet fragmentation from megakaryocytes; these differentiated from megakaryoblasts

29 Slides ASCP 2-49 Megakaryocyte IdentificationASCP 2-49 Megakaryocyte Identification ASCP 2-52 Active (Platelet forming) Bone Marrow MegakaryocytesASCP 2-52 Active (Platelet forming) Bone Marrow Megakaryocytes ASCP 2-53 Platelets in bone marrow last of the platelets released; nucleus remainsASCP 2-53 Platelets in bone marrow last of the platelets released; nucleus remains

30 Medical Histology Thrombocytopenia Increased Destruction and UtilizationIncreased Destruction and Utilization Impaired ProductionImpaired Production

31 Slides ASCP BM:ASCP BM: Rodak 208 BM Aspirate with numerous megakaryocytes, but few or no platelets seen in the peripheral bloodRodak 208 BM Aspirate with numerous megakaryocytes, but few or no platelets seen in the peripheral blood

32 Hematopoiesis Monocyte maturation from monoblastMonocyte maturation from monoblast LymphocytesLymphocytes

33 Question A 54 year old man has a neoplastic disorder that shows a peripheral blood leukocytosis with a predominance of mature neutrophils, few myelocytes, metamyelocytes, and promyelocytes. Myeloblasts are not identified What is the most likely diagnosis? A.Acute leukemia B.Chronic leukemia C.Lymphoma

34 Question Peripheral blood smear. Identify this cell A.Nucleated red blood cell B.Polychromatophilic red blood cell C.Reticulocyte D.Polymorphonuclear neutrophil E.Eosinophil

35 Question This basophilic staining large cell is present in the peripheral blood of a patient appropriately treated for anemia. What is the most like cause for this coloration? A.Iron granules B.Neoplastic primary granules C.Residual DNA D.Residual RNA

36 Question Which of the following hematologic evaluations is most likely to give useful information about the maturation and cytology of the erythroid and granulocytic series? A.Bone marrow aspiration B.Bone marrow core biopsy C.Complete blood cell count


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