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bonemarrowexamination-190709053159 (1).pptx
- 1.
- 2. • It providesthe semi - quantitative & qualitative assessment of the state of hematopoiesis. • It can be 1. Bone marrow aspiration 2. Bone marrow biopsy Needs ?
- 3. 1. Cortex -outer 2. Medulla - inner Structure of bone
- 4. • One ofthe largest organ in the body • Located with in the cavities of the bone • Consists of • Hematopoietic cells • Vascular sinusoids • Fibroblasts • Fat cells • Macrophages • No lymphatic channels in the Normal bone marrow
- 5. Red marrow 1. Activeportion 2. Contain hematopoietic cells Normal value : 3000-4000ml Red marrow : 1500ml 1. Inactive portion 2. Contain fat cells Types Yellow marrow
- 6. • Amount offatty tissues depends on activity of the hematopoietic cells. • Children's - 20-30% of fat cells • Adults - 50% of fat cells • Elder - 70% of fat cells.
- 7. 1. Unexplained cytopenias 2.Suspected acute leukemia 3. Suspected MDS 4. Suspected MPD 5. Suspected Plasma cell disorders 6. Suspected CLL 7. PUO 8. Suspected storage disorders 9. Suspected infections Aspiration indication
- 8. 1. Repeated failureof aspiration 2. Suspected Aplastic anemia 3. Suspected Myelofibrosis 4. Suspected Focal lesions like granuloma, metastatic deposits. 5. Suspected hairy cell leukemia 6. Staging of lymphoma. Biopsy indication
- 9. 1. Coagulation disorders 2.Local infections Contraindication
- 10. • Posterior iliaccrest • Large reservoir of marrow • No large blood vessels • No nerves close to this area • Sternum • At the 2nd intercostal space in midline • Tibia • <1 year • Medial aspect of upper end of tibia • Iliac spines or crest > 1 year Sites
- 11.
- 12. 1. Informed consent 2.Sterile tray 3. Position of the patient 4. Skin & periosteum infiltrated with local anesthetic agents 5. Wait for 5 minutes Aspiration procedure
- 13. • Needle isinserted with stylet (prevent the blockage of the lumen by tissues) • Once reach the bone needle rotate clock & anti clock wise • Decreased resistance felt once reach the bone marrow • Needle advanced into the marrow 1-2 mm • Small amount(0.25-0.50ml or till the 1st drop of blood appears) of marrow aspirated by using 5 or 10 ml syringe
- 14. • Sedatives –Intravenous , General • Percutaneous trephine biopsy material commonly obtained from posterior superior iliac spine • Rotating it clockwise 10 times • Needle removed by anti clock wise • 1.6cm in length • Fixative solution ( Helly’s Fluid) Biopsy procedure
- 15. 1. Local infections 2.Hemorrhage 3. Cardiac tamponade 4. Mediastinitis Complications
- 16. Parameters Aspiration Biopsy SiteIliac spine, Sternum, Iliac spine Information Morphology Cytochemistry Iron stain Culture Cellularity Architecture Focal lesions Needle Salah Klima Jamshidi Stain Romanowsky stain Iron stain H & E stain Reticulin stain Result Same day With in 7 days Comparison
- 17. 1. Cellularity (Deducting 1 for each year of age from 100) 2. Differential count 3. Myeloid : Erythroid ratio ( 2:1 to 4:1) 4. Erythroid series 5. Myeloid series 6. Megakaryocyte series 7. Lymphocyte series 8. Plasma cell series 9. Abnormal cells 10. Parasites Aspiration examination
- 18. 1. Megakaryocyte 2. Fatcells 3. Cellular trails Identification
- 19.
- 20. Erythroid hyperplasia Giant metamyelocytes Bandforms Megaloblastic anemia Megaloblastic series are seen
- 21. 1. Large 2. DeepBasophilic cytoplasm 3. Prominent nucleoli 4. Fine nuclear chromatin
- 22. 1. Needs ? 2.Types ? 3. Indications ? 4. Name of the aspiration needle? 5. Name of the biopsy needle? 6. Identification ? 7. Bone marrow findings of IDA & MA? Assessment