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MLAB 1415- Hematology Keri Brophy-Martinez

MLAB 1415- Hematology Keri Brophy-Martinez. Chapter 35: Bone Marrow. Bone Marrow. Bone marrow differentiates into myeloid, erythroid and lymphoid cell lineages under the influence of cytokines or growth factors.

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MLAB 1415- Hematology Keri Brophy-Martinez

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  1. MLAB 1415- HematologyKeri Brophy-Martinez Chapter 35: Bone Marrow

  2. Bone Marrow • Bone marrow differentiates into myeloid, erythroid and lymphoid cell lineages under the influence of cytokines or growth factors. • Function: supply mature hematopoietic cells into peripheral blood and respond to demands

  3. Bone Marrow • Highly vascularized loose connective tissue • Organized around bone vasculature • Located between trabeculae of spongy bone • Composed of 2 major compartments • Hematopoietic • Vascular

  4. Indications for BM Evaluation • Hematological and nonhematological disorders often requires BM evaluation for • Diagnosing • Managing • Making prognoses • Following up on disorders • Bone marrow should be evaluated together with • Peripheral blood counts • Peripheral blood smear

  5. Indication for Bone Marrow Studies • Hematologic diseases • Anemia, erythrocytosis, polycythemia • Leukopenia and unexplained leukocytosis • Appearance of abnormal or immature cells in the peripheral blood circulation • Thrombocytopenia or thrombocytosis • Systemic disease • Solid malignant tumors elsewhere in the body - done at initial diagnosis to determine the degree of tumor spread and to stage the malignancy • Infections known as “fever of unknown origin” (FUO) in which organisms may be within the marrow. • Certain histiocytic diseases

  6. Bone Marrow Procedure • Sites of hematopoiesis • Differ by age • Certain disease states • Red marrow can extend into long bones • Cellularity within red marrow decreases with age • Adipose tissue replaces hematopietic tissue

  7. Bone Marrow Procedure • Marrow specimens • After adolescence • Posterior superior iliac crest • Occasionally sternum and anterior iliac crest • < 2 years of age • Anterior tibia • Older children • Spines of the lumbar vertebral bodies L1 and L2

  8. Laboratorian’s role in bone marrow procedure • Provide necessary equipment • Preparation of the specimen for analysis • Use sterile technique • Make direct smears from the aspirate • Make crush smears from the marrow spicules • Place extra aspirate into anticoagulated tubes • Performance of the preliminary exam and processing

  9. Bone Marrow Equipment • Bone marrow aspirates and biopsies • Obtained using disposable needles • Jamshidi trephine needle (8 or 11 gauge) • Sterile technique always used

  10. Processing the specimen in the lab • Place EDTA specimen (liquid aspirate) in Wintrobe tube and centrifuge at low speed. • Measure layers formed by centrifugation • FPV - fat and perivascular • used for iron stain • Plasma • Buffy coat (myeloid:erythroid cells- M:E) Normal is 4:1. M:E is the ratio between all granulocytes and their precursors and all nucleated red cell precursors. • RBC’s

  11. Processing the specimen in the lab • Prepare and stain ME smears. • Deliver clot remaining in syringe and biopsy to histology for processing. • Deliver other specimens obtained such as viral, fungal or routine culture specimens to microbiology. • Complete paperwork and package specimens to be sent out to reference lab

  12. Information derived from specimens • Direct smear from syringe tip - evaluation of cellular morphology with Wright’s stain • Particle (crush) smear - evaluation of cellularity and the relationship of cells to each other • M:E smear - evaluation of hematopoietic cells and M:E ratio • Biopsy • If marrow cannot be aspirated (“dry tap”), this is the only specimen for examination • Examination for malignancy for clinical staging of lymphomas and cancers • Examination of the architecture of the bone marrow and the cells in their natural relationship to each other • Trephine imprint (touch prep) - examination of cells with Wright’s stain; may be the only source to study cellular detail if an aspirate is not obtained

  13. References • Harmening, D. M. (2009). Clinical Hematology and Fundamentals of hemostasis (5th ed.). Philadelphia, PA: F.A. Davis Company. • McKenzie, S. B. (2010). Clinical Laboratory Hematology (2nd ed.). Upper Saddle River, NJ: Pearson Education, Inc. • http://www.gesundheitsinformation.de/fact-sheet-preventing-osteoporosis.423.en.html • http://medsurge.tradeindia.com/Exporters_Suppliers/Exporter5792.75835/Jamshidi-Bone-Marrow-Aspiration-Needles.html

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