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Hematology Lecture 12: LMU
Examination of the Bone Marrow; Introduction to the Anemias
Terms in this set (39)
- Birth: all bones contain red marrow
- 5th to 7th year: yellow marrow begins to replace red marrow
- Adult: 50% yellow marrow; 50% red marrow
Human bones consist of a dense outer layer called the _______ and a central spongy area of _________ _______.
- trabecular bone
Trabecular area consists of:
- yellow marrow
- capillary network supported by fibrous tissue; capillaries form a complex network called the marrow sinus, which returns blood to the venous system
Hematopoiesis occurs between the branches of the marrow sinus in areas called _______.
What is the Erythropoietic Island?
a macrophage surrounded by a cluster of maturing erthyroblasts
Cellular Area of the Bone Marrow:
What are common reasons for a bone marrow aspirate to be done?
- unexplained anemia: EXCEPT iron deficiency anemia or megaloblastic anemia
- circulating blasts in the peripheral blood
- pancytopenia (aplastic anemia)
- splenomegaly, lymphadenopathy, hepatomegaly
- X-ray evidence of bone lesions
- Hodgkin lymphoma, non-Hodgkin lymphoma
Tumor cells in the bone marrow:
What are the acceptable bone marrow sites for an adult? pediatrics?
- Adult: iliac crest, sternum
- Pediatrics (<1 years old): tibia
What are spicules?
tiny bone particles that tell the physician it is truly marrow and not just sinusoidal blood
What are the 2 components of the BM aspiration?
- bone core biopsy
What is the significance of the aspirate?
determines the types and proportions of the hematopoietic cells in the marrow
What is the significance of the bone core biopsy?
primarily for focal lesion disorders rather than diffuse involvement of the marrow
What is a "dry tap"? What are 2 causes of a "dry tap"?
- no cells obtained in the BM procedure
- core biopsy is mandatory
- causes: true hypocellularity (aplastic anemia); myelofibrosis
What are the normal conditions for a bone marrow aspirate?
- large amount of cells present
- 500 differential cell count to determine the M:E ratio
What is the normal M:E ratio for adults?
What is the myeloid component of the M:E ratio?
all cells of the granulocytic series, both mature and immature
What is the erythroid component of the M:E ratio?
all nucleated RBCs (nucleated RBC precursors)
M:E Ratio Example:
If a patient's BM shows a total percent of myeloid cells to be 64 and the NRBC total percent to be 8, then the M:E ratio is:
64:8 or 8:1
What is hypocellular marrow?
- red marrow is being replaced with yellow marrow
- examples: bone marrow failure; aplastic anemia
What is hypercellular marrow?
- decreased amount of fat marrow, increased amount of nucleated cells
What is erythroid hyperplasia?
- common in some anemias (low survival rate of RBC precursors)
- increased number of RBC precursors
- M:E ratio may be: 2:1 or 1:1
What is myeloid hyperplasia?
- increased number of WBC precursors
- myelogenous leukemia; myeloproliferative disorders
- M:E ratio may be: 8:1 or 10:1
What is the most common granulocyte found in the BM?
What is the most common NRBC found in the BM?
What is the megakaryocyte average in the BM?
1-3 megakaryocytes per low power field
What are the largest cells in the BM?
What are osteoblasts?
- bone cells responsible for the formation of bone (bone synthesis)
- resemble plasma cells but with mottled cytoplasm and no well defined "area of hof"
What are osteoclasts?
- bone cells responsible for resorption of bone (bone removal)
- multinucleated and very large
Prussian Blue Stain - Normal Iron Stores:
Prussian Blue Stain - Absent Iron Stores:
Prussian Blue Stain - Increased Iron Stores:
Sideroblastic or Hemochromatosis
What is anemia?
- decrease in H/H below the previously established reference values for healthy individuals of the same age, gender, and race
What are symptoms of anemia?
- weakness, fatigue, shortness of breath
- pale coloration under eyelids, nailbeds, and skin
- rapid anemia caused by acute blood loss is associated with hypotension and tachycardia
What are 4 causes of anemia?
- decreased RBC production
- ineffective RBC or HgB production
- increased RBC destruction or loss
- pseudo-anemia (increased plasma volume)
What is the role of erythropoietin (EPO)
- made in the kidney
- stimulates RBC production
- released in response to lowering oxygen tension
- MCV: < 80 fL
- MCHC: <32 g/dL
- MCV: > 100 fL
- MCHC: >32 g/dL
- MCV: 80 - 100 fL
- MCHC: 32 - 36 g/dL
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