Bone Marrow Analysis Zhao xindong

I. Degrees of marrow cellularity A.Marked or Moderate Hypercellularity 1.Malignant proliferation of abnormal cells 2.Hemopoietic hyperplasia (1)Hyperplastic anemia (2)Mageloblastic anemia

B.Hypercellularity 1.Normal BM 2.Certain anemias

C. Hypocellularity 1.Hemopoietic depression 2.Marrow diluted by blood

Differential Diagnosis Hypoplasia BM diluted Naked eye BM granules * Rarely visible or fatty drop Microscopy Specific cells * Rarely visible of BM Band >segmented * Band < segmented Hemopoietic cells Hemopoietic islands, Megakryocytes Nonhemopoitic cells Plasma cell,Mast cell Osteoblast, Osteoclast

II.M/E ratio 1.M:E= ↑( ≥ 5:1) (1)M ↑ :Infection,leukemoid reaction, AML,CML (2)E ↓ :Pure red cell aplasia ( PRCA)

2.M:E = N (3~4:1 ) (1)Normal marrow (2)M ↑:E ↑ =N. Erythroleukemia, Polycythemia vera (PV ), CML (3)M ↓:E ↓ =N. AA, Myelofibrosis, MM,ALL

(1)M↓: leukopenia, Neutropenia (2)E ↑: Hyperplastic Anemia 3.M :E = ↓ (≤ 2:1 ) or inversion (1)M↓: leukopenia, Neutropenia (2)E ↑: Hyperplastic Anemia MA,PV,Erythremia.

Targets of Myeloid Hyperplasia 1.Degrees of marrow cellularity. 2.Myeloid to erythroid ratio 3.Myeloid mitotic cells 4.Myeloid series occupy % of all nucleated cells.

Morphologic Abnormalities of Myeloid series 1.Abnormal cell 2.Abnormal nucleus 3.Abnormal Cytoplasm

1、Abnormal cell (1)Abnormal shape (2) Development of nucleus and cytoplasm is disproportionate 2、Abnormal nucleus (1)Pelger-huet anomaly (2) Degeneration of nucleus (3) Hypersegmented neutrophils

It may be found in CML,MDS or inherited. Pelger-Huet anomaly: All of the neutrophils have no more than a bi-lobed nucleus. The nuclear chromatin is coarsely clumped. It may be found in CML,MDS or inherited.

Hypersegmented neutrophils

3、Abnormal cytoplasm (1) Toxic granules (2)Vacuoles (3) Dohle bodies: Inclusion body, a small light blue-staining area in cytoplasma of neutrophil,is found in infections, poisoning, burns following chemotherapy.

(4)Auer rods: are rod-like bodies that stain a reddish purple, they are found only in the cytoplasm of the blast cells in acute monocytic or acute myelogenous leukemia or MDS-RAEBt

Myeloid Hyperplasia --Myeloblasts ↑:AML,CML-CP, AMMoL -- Promyelocytes ↑ :APL -- Myelocytes ↑:M2b -- Metamyelocytes and Bands ↑:CML

Myeloid Hyperplasia -- Eosinophilic Granulocytes ↑ Allergic conditions Parasitic infections eosinophilic leukemia chronic myelocytic leukemia

Myeloid Hyperplasia --Basophilic Granulocytes ↑ basophilic leukemia chronic myelocytic leukemia

Myeloid Hypoplasia Neutropenia: hypoplasia, mature suppression. Aplastic Anemia. Aplastic Crisis. Borrow marrow Examintion

Erythroid Hyperplasia Pronormoblast,Early normoblasts↑: EL Polychromatic normaoblasts and Orthochromatic normaoblasts ↑ : HA,IDA,MA Orthochromatic normaoblasts ↑:IDA

Targets of Erythroid Hyperplasia. Degrees of marrow cellularity. Myeloid to erythroid ratio Erythroid mitotic cells Normoblasts occupy % of all nucleated cells.

Targets of Erythroid Maturation. Late normoblasts ratio in erythron Absolute reticulocytes in blood RBC in blood.

Erythroid Hypoplasia Aplastic Anemia( AA) Pure Red Cell Aplasia( PRCA) Acute Arrest of Hemopoiesis. ( AAH)

Hyperplasia of Megakaryocytic Series Megakaryblasts >30% Ameg- L . Megakaryocytes CML,PV, Acute Hemorrhage. Megakaryocytes with mature depression. ITP, Evan Syndrome

Hypoplasia of Megakaryocytic Series -- Acute leukemia --AA --Myelofibrosis

Lymphocyte Series 1.Lymphoblast and prolymphocyte (1)ALL (2)crisis of CLL (3)Mixed acute leukemia (MAL) (4) Crisis of CML (5) Prolymphocytic leukemia (PLL) (6)Lymphoma

2.Lymphocyte (1) CLL (2)Leukemoid reaction (3)Infectious mononucleosis(IM) (4)Infectious Lymphocytosis (5)Virus Infections

Monocyte series 1.Monoblast (1)Acute monocytic leukemia (AMOL) (2)Acute Myelomonocytic leukemia (AMMOL)

2.Promonocyte (1) Acute monocytic leukemia (2) MDS-CMMOL (3)Malignant tumor.

Monocyte series 3.Monocyte (1) Leukomoid Reaction (2) maligant tumor

Plasmatic series 1.Plasmablast and Proplasmacyte (1)Multiple Myeloma (MM) (2) Plasma cell leukemia (PCL) 2.Plasmacyte (1)ITP (2) AA (3)Waldenstron’s macroglobulinemia

Histocytosis (1)Malignant Histocytosis(MH) (2)Histocytic type Lymphoma (3)Infectious diseases