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1、Testingofbonemarrowcytology 2 Thecontent methodandclinicalsignificanceofthebonemarrowcytomorphologicexamination Thetestofbonemarrowslidesiscarriedoutasfollows 1 lowpowerscan 1 makesureifthematerial drawingandthefilmpreparationofbonemarrowaspirationissatisfied Thespecimenshouldbeconsistedof3parts the
2、head thebodyandthetail 2 judgetheextentofbonemarrowhyperplasia Theextentofbonemarrowhyperplasiaisreflectedbytheamountofkaryocytesinbonemarrowgenerally Observetheratioofkaryocytetomatureerythrocyteunderlowpower Theextentofbonemarrowhyperplasiaispositedusingthe5gradesclassification 3 observemegakaryoc
3、ytes Fourprincipalaspectsaboutmegakaryocytesshouldbeinspected 1 amount2 degreeofmaturity3 functionofgeneratingplatelets4 shapeofmegakaryocytesandplatelets 4 checkwhetherabnormalcellsexist AbnormalhistiocyteMetastaticcarcinomacellGauchercellNiemann Pickcell Onceabnormalcellswerefound theyshouldbeinsp
4、ectedunderoilimmersion 2 oilimmersionassayChoosetheboundariesofthefilm scoatingbodyandtail 1 countthekaryocytesdifferentially Calculatetheratioofthegranulocytetotheerythrocyte G E 2 observethemorphologyofcells Includingtheshapeofmatureerythrocyteandwhetherspecialabnormalcellandparasiticagentsabound
5、3 theclinicalsignificanceoftheresultTheextentofbonemarrowhyperplasia 1 extremelyactivehyperplasiaReflectthehyperfunctionofbonemarrowhematogenesisConditions leukemia esp chronicmyelocyticleukemia CML 2 themanifestlyactivehyperplasiaReflectthevitalityofbonemarrowhematogenesisConditions hyperplasticane
6、mia leukemia proliferatingbonemarrowdiseases idiopathicthrombocytopenicpurpura ITP hypersplenia 3 theactivehyperplasiaReflectthebasicallynormalconditionofbonemarrowhematogenesisConditions normalbonemarrow hyperplasticanemia chronicaplasticanemiawithlocalcompensatoryhyperplasia 4 thedecreasedhyperpla
7、siaReflectthedecreasedfunctionofbonemarrowhematogenesisConditions chronicaplasticanemia granulocytopenia agranulemia myelofibrosis 5 remarkablydecreasedhyperplasiaReflectthenonfunctionofbonemarrowhematogenesisConditions acuteaplasticanemia bonemarrownecrosis Theratioofcellsineachseriesateachdevelopi
8、ngphaseinbonemarrow GranulocyteseriesAlmost50 60 ofkaryocytesaregranulocytes Withcellmaturity theratioofeachdevelopingphaseincreased MyeloblastsegmentedgranulocytesMostoftheeosinophilicgranulocytesandthebasophilicgranulocytesareusuallymatureinbonemarrow eosinophilicgranulocytes 5 basophilicgranulocy
9、tes 1 2 ErythrocyteseriesNormoblasts 20 Pronormoblast 1 Basophilicnormoblast 5 Polychromaticnormoblast 10 Orthochromaticnormoblast 10 G Eisdefinedastheratioofthepercentageofgranulocyteseriestoerythrocyteseries Referencevalue 2 4 1 3 LymphocyteseriesThepercentageofcellsoflymphocyteseriesisapproximate
10、ly20 ofkaryocytes Higherinchildhood itevengoesupto40 Maturelymphocytes majorityLymphoblastsandprolymphocytes rare 4 Monocyteseries 4 almostallofthecellsarematuremonocytes 5 PlasmacyteseriesUsu 2 mainlymatureplasmacytes 6 MegakaryocytesystemInafilmpreparationof1 5cm 3 0cm thenormalvalueisdefinedas7 3
11、5megakaryocytescanbeseen Granularmegakaryocytesandthrombocytogenousmegakaryocytes commonlyseenMegakaryoblasts seldombeseenAmongthemegakaryocytesystem Promegakaryocyte 5 Granularmegakaryocytes10 27 thrombocytogenousmegakaryocytes44 60 Nakedmegakaryocyte8 30 7 OthercellsAfewnon hemapoieticcellscanbese
12、en e g reticulocytes endotheliocytes tissuebasophiliccells etc Clinicalsignificanceofchangesinratioofeachseries Changesofratioofgranulocytesanderythrocytes G E Cytochemicalstainingofthebloodcell Thecytochemicalstainingisakindofassay basedoncellmorphology whichuseschemicalreactionprinciples stainingb
13、onemarrowslidesaccordingtoacertainprocedure andatlastobservingthecytochemistrycompositionanditschangesasseenonthemicroscope Itcanbeusedintheidentificationofcategoryofbloodcells 1 Peroxidasestaining POX Result noblueorblackparticlesinthecytoplasm Tinyanddiffuselydistributedgranulesinthecytoplasm weak
14、lypositiveThickanddensegranules stronglypositiveSignificance identifythecategoryofacuteleukemiaAcutemyeloblasticleukemia stronglypositiveAcutemonocyticleukemia weaklypositiveor Acutelymphoblasticleukemia POXismostvaluableintheidentificationofAMLandALL 2 SudanblackBstaining SB Akindoffat solublestain
15、 canmaketheintracytoplasmiclipidturntobrownish blackordeepblackparticles Result almostthesameasPOX Granulocyteseries na ve mature thepositivereactionbecomesstrongerMonocyteseries weakly Lymphocyteseries Significance thesameasPOX 3 Neutrophilalkalinephosphatasestaining NAP Result ALPmainlyexistsinthe
16、matureneutrophilicgranulocyte staborsegmented othercells Positiveresult graytobrownish blackparticlesinthecytoplasmTheintensityofresponsecanbedividedinto5grades 1 2 3 4 Theresultispresentedasthepercentageofthepositivecellsandthescore ReferencevalueAdult positiveratioofNAP 10 40 thescore 40 80pointsSignificance acutefesteredinfectiousdiseases remarkably viralinfections normalofslightly CML remarkably usu score0 leukemoidreaction extremely AML ALL acutemonocyticleukemia normalor Aplasticanemia PNH
