Hematopoietic System 1 Bone Marrow Hematopoiesis

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Hematopoietic System- 1Bone Marrow Hematopoiesis

• Linda F. Cunningham, MD
• January 2, 2003

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Hematopoietic SystemBone Marrow

• Hematopoietic active marrow with stem cells,
  progenitor cells, and developing erythroblasts,
  myeloblasts, and megakaryoblasts (red marrow)
• Adipose cells, various with age and activity
  (yellow marrow)
• Marrow sinuses and capillary network

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Slide

• ASCP Bone Marrow 3
• Histology 6.2 Trabecular bone with hematopoietic
  tissue and fat
• Rodak 7 Bone Marrow with hematopoietic tissue,
  capillaries, and fat
• Rodak 76 Core Biopsy shows 50 fat and 50
  hematopoietic tissue

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Hematopoietic SystemBone Marrow

• Amount of red marrow varies with age of patient
• Childhood Red marrow is 100 of BM and present
  in virtually every bone
• Adults Red marrow is 50 of BM and present in
  sternum, ribs, pelvis, and skull
• 70 years Red marrow reduced to 30 of the BM

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Slides

• Slide -Changes in site for Hematopoiesis with age
• Bone Marrow in Skeleton Rodak 4
• Bone Marrow Biopsy Site Rodak 66
• ASCP Bone Marrow 13 Cellular, 5 y.o
• 14 Less Cellular 35 y.o.
• 30 Hypocellular, aplastic anemia

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Clinical Evaluation Tests of Bone Marrow
Function

• Small amounts of myeloid tissue (myelosmarrow)
  is removed from bone cavity and examined under
  the microscope-
• Bone marrow aspiration
• Bone marrow biopsy

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Hematopoietic SystemBone Marrow

• Bone Marrow Core Biopsy
• Cellularity and the architecture
• Bone Marrow Aspiration
• Cytology and maturation

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Slides

• Rodak 76 Core biopsy Cellularity 50
• ASCP BM 237 AIDS granuloma
• 204 Spindle cells
• Robbins 338 Hypoplastic
• Pathology 13.26 Hyperplastic
• Pathology 13.27 Hyperplastic due to acute
  leukemia

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Slides

• Bone Marrow Aspiration
• Rodak 67 Aspirate smear
• Rodak 68 Myeloblast, promyelocyte, myelocyte,
  and lymphocyte
• Rodak 71 Bands and segs

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Hematopoiesis

• Key Terms
• Stem cells
• Precursors cells (Blasts)
• Terms for each stage in the morphologic
  differentiation

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Hematopoiesis

• Myeloblast
• Promyelocyte
• Myelocyte
• Metamyelocyte
• Band cell
• Mature granulocyte (neutrophil, eosinophil, or
  basophil)

• Proerythroblast
• Basophilic erythroblast
• Polychromatophilic erythroblast
• Orthrochromatophic erythroblast
• Reticulocyte
• Erythrocyte

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Slides

• RBC Maturation
• Harmening1-3
• Histology 6.5
• ASCP 2.6
• 2.9
• 2.7
• 2.10

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Slides

• 2.12
• 2.14
• 2.15
• CAP Polychromasia
• CAP Reticulocyte stain

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Medical HistologyRBC Maturation Sequence

• The red cell maturation sequence and significance
  of the change in red cell size and cytoplasmic
  color
• Polychromatophilic red blood cells to illustrate
  newly released red cells
• Reticulocytes to illustrate bone marrow response
  to anemia
• Nucleated red blood cells in peripheral blood to
  illustrated bone marrow stress

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Slides

• Diagram of red cell maturation and time sequence
• Normal red blood cells
• CAP Polychromasia
• CAP Reticulocyte stain

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Slides

• ASCP 4-30 Polychromatophilic RBC with basophilic
• ASCP 2-17 Reticulocyte stained with methylene
  blue
• ASCP 2-18 Normal mature RBC
• ASCP4-33 and 34 RBC and Rete stain
• CAP Nucleated red blood cell

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Medical Histology Erythropoiesis

• Recognize the bone marrow response to anemia
• Accelerated Erythropoiesis
• Released Reticulocytes
• Insufficient Erythropoiesis
• Inadequate reticulocytes

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Medical Histology Bone Marrow and Red Cell Size

• Recognize the clinical significance of size of
  red cells
• Recognize the size change with maturation
• Classify anemia based on red cell size
• Small Microcytic
• Large Macrocytic
• Normal Normocytic

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Slides

• Histology Figure 6-5 Stages
• ASCP 2-06 Pronormoblast and orthroblast
• ASCP 2-12 Orthro and polychrom
• ASCP 2-15 Poly, orthro, polychromatophilic RBC
• ASCP 2-14 Orthro losing its nucleus, late poly

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Slides

• Rodak 86 Iron Deficiency
• ASCP 4-16 Iron Deficiency
• ASCP 4- 20 Macrocytic with Lymphocyte

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Hematopoiesis

• Myeloblast
• Promyelocyte
• Myelocyte
• Metamyelocyte
• Band cell
• Mature granulocyte (neutrophil, eosinophil, or
  basophil)

• Proerythroblast
• Basophilic erythroblast
• Polychromatophilic erythroblast
• Orthrochromatophic erythroblast
• Reticulocyte
• Erythrocyte

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Slides

• Histology 6.8 all stages
• Harmening 1-17 Blast, promyelocyte, myelocyte,
  metamyelocyte, band, segmented eosinophil
  myelocyte, metamyelocyte, band, and mature
  eosinophil
• ASCP 2-22 Myeloblast and promyelocyte
• ASCP 2-25 Promyelocyte, myelocyte, band,
  segmented neutrophil

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Medical HistologyNeutrophilia and Immature Cells

• Leukocyte Maturation and Response to Infection
  produces a left shifted maturation early cells
  in the peripheral blood
• Increased numbers of neutrophils leave the bone
  marrow storage spaces
• Increased neutrophil production
• Immature forms - bands, metamyelocytes, and even
  myelocytes leave the bone marrow

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Slides

• Leukocytosis with left Shift

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Medical HistologyLeukocyte Maturation

• Leukemia and Maturation of Leukocytosis
• Acute Leukemia Immature cells
• Granulocyte maturation AML
• Lymphocyte maturation ALL
• Chronic Leukemia Mature cells
• Granulocyte maturation CML
• Lymphocyte maturation CLL

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Slides

• Saunders 349 Lack of maturation, monotonous
  population, acute leukemia
• CAP HE-23 Mature lymphocyte and lymphoblast
• ASCP 6-10 Maturation of granulocytic cells in CGL

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Slides

• Cancer 13.18 Maturation of granulocytic cells
• ASCP 6-40 Maturation of granulocytic cells
• ASCP 6-45 and 6-46 CLL monotonous population
• CAP HE-25 Normal lymphocyte
• Saunders 353 CLL

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Platelet Maturation

• Platelet fragmentation from megakaryocytes
  these differentiated from megakaryoblasts

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Slides

• ASCP 2-49 Megakaryocyte Identification
• ASCP 2-52 Active (Platelet forming) Bone Marrow
  Megakaryocytes
• ASCP 2-53 Platelets in bone marrow last of the
  platelets released nucleus remains

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Medical HistologyThrombocytopenia

• Increased Destruction and Utilization
• Impaired Production

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Slides

• ASCP BM
• Rodak 208 BM Aspirate with numerous
  megakaryocytes , but few or no platelets seen in
  the peripheral blood

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Hematopoiesis

• Monocyte maturation from monoblast
• Lymphocytes

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Question

• A 54 year old man has a neoplastic disorder that
  shows a peripheral blood leukocytosis with a
  predominance of mature neutrophils, few
  myelocytes, metamyelocytes, and promyelocytes.
  Myeloblasts are not identified What is the most
  likely diagnosis?
• Acute leukemia
• Chronic leukemia
• Lymphoma

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Question

• Peripheral blood smear. Identify this cell
• Nucleated red blood cell
• Polychromatophilic red blood cell
• Reticulocyte
• Polymorphonuclear neutrophil
• Eosinophil

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Question

• This basophilic staining large cell is present
  in the peripheral blood of a patient
  appropriately treated for anemia. What is the
  most like cause for this coloration?
• Iron granules
• Neoplastic primary granules
• Residual DNA
• Residual RNA

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Question

• Which of the following hematologic evaluations
  is most likely to give useful information about
  the maturation and cytology of the erythroid and
  granulocytic series?
• Bone marrow aspiration
• Bone marrow core biopsy
• Complete blood cell count