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Hematopoietic System- 1 Bone Marrow Hematopoiesis

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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) Adipose cells, various with age and activity (yellow marrow) Marrow sinuses and capillary network

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

4 Hematopoietic System Bone Marrow
Amount 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 age
Bone Marrow in Skeleton Rodak 4 Bone Marrow Biopsy Site Rodak 66 ASCP Bone Marrow 13: Cellular, 5 y.o 14: Less Cellular 35 y.o. 30: 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%
ASCP BM 237: AIDS granuloma #204: Spindle cells Robbins #338 Hypoplastic Pathology Hyperplastic Pathology Hyperplastic due to acute leukemia

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

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

11 Hematopoiesis Myeloblast Proerythroblast Promyelocyte
Metamyelocyte Band cell Mature granulocyte (neutrophil, eosinophil, or basophil) Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthrochromatophic erythroblast Reticulocyte Erythrocyte

12 Slides RBC Maturation Harmening1-3 Histology 6.5 ASCP 2.6 2.9 2.7 2.10

13 Slides 2.12 2.14 2.15 CAP Polychromasia CAP 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 sequence
Normal; red blood cells CAP Polychromasia CAP Reticulocyte stain

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

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

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

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

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

21 Hematopoiesis Myeloblast Proerythroblast Promyelocyte
Metamyelocyte Band cell Mature granulocyte (neutrophil, eosinophil, or basophil) Proerythroblast Basophilic erythroblast Polychromatophilic erythroblast Orthrochromatophic erythroblast Reticulocyte Erythrocyte

22 Slides Histology 6.8 all stages
Harmening 1-17: Blast, promyelocyte, myelocyte, metamyelocyte, band, segmented; eosinophil myelocyte, metamyelocyte, band, and mature eosinophil ASCP 2-22: Myeloblast and promyelocyte ASCP 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 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 Shift

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

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

27 Slides Cancer 13.18 Maturation of granulocytic cells
ASCP 6-40 Maturation of granulocytic cells ASCP and 6-46 CLL monotonous population CAP HE-25 Normal lymphocyte Saunders #353 CLL

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

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

30 Medical Histology Thrombocytopenia
Increased Destruction and Utilization Impaired Production

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

32 Hematopoiesis Monocyte maturation from monoblast Lymphocytes

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? Acute leukemia Chronic leukemia Lymphoma

34 Question Peripheral blood smear. Identify this cell
Nucleated red blood cell Polychromatophilic red blood cell Reticulocyte Polymorphonuclear neutrophil 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? Iron granules Neoplastic primary granules Residual DNA 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? Bone marrow aspiration Bone marrow core biopsy Complete blood cell count

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