1. Bone Marrow Analysis
Zhao xindong

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

5. B.Hypercellularity
1.Normal BM 2.Certain anemias

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

7. 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

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

9. 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

10. (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.

12. 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.

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

14. 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

15. 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.

16. Hypersegmented neutrophils

17. 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.

18. (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

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

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

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

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

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

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

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

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

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

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

33. 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

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

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

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

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

38. 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

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