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[MT 6318] Hematology Lecture > [2S] Bone Marrow Examination (Meme) > Flashcards

[2S] Bone Marrow Examination (Meme) Flashcards

1
Q

Refers to the pathologic analysis of samples of bone marrow

A

BONE MARROW EXAMINATION

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2
Q

Obtained by bone marrow aspiration and biopsy which is often called the _____

A

fine biopsy

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3
Q

It is a soft gelatinous tissue that fills the medullary cavities which are the centers of the bones

A

Bone Marrow

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3
Q

It is used in diagnosis of a number of conditions including leukemia, multiple myeloma, lymphoma, anemia, and pancytopenia

A

BONE MARROW EXAMINATION

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4
Q

Is the soft spongy gelatinous tissue found in hollow spaces in the interior of bones

A

Bone Marrow

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5
Q

T/F: The average rate of bone marrow tissue is about 3.4 – 5.9% of total body weight or 1.6 – 3.7 kg in an adult weighing 65 kg

A

T

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5
Q

Progenitors or stem cells of the bone marrow produce new blood cells, stromal cells numbering about _______ per kilogram per day in the process hematopoiesis.

A

6 billion

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6
Q

HEMATOPOIETIC SITES

T/F: At birth and up to the time as the child reaches the age of 6, hematopoietic stem cells are found in almost ALL BONE MARROW of the entire skeletal system

A

F; age of 5

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7
Q

HEMATOPOIETIC SITES

T/F: This fatty metamorphosis (yellow marrow) increases approximately 10% per decade after age of 70

A

T

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7
Q

HEMATOPOIETIC SITES

At the age of around 5 to 7 years, there is a start of the development of the _________ which is made up of fat cells or adipocytes.

A

yellow marrow

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8
Q

HEMATOPOIETIC SITES

Occupy approximately 50% of the red hematopoietic marrow in a 30-70 year old adult

A

Yellow Marrow

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9
Q

T/F: Bone marrow examination is an invasive procedure so that it is not performed as a routine one

A

T

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10
Q

Diagnose neoplasia

A

Bone Marrow Examination

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11
Q

May also be necessary for the diagnosis in staging of Hodgkin and non-Hodgkin lymphoma

A

Bone Marrow Examination

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12
Q

also used to determine the cause of Cytopenia

A

Bone Marrow Examination

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13
Q
  • Determine metabolic disorders
  • Determine infections
  • Monitor treatment
A

Bone Marrow Examination

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14
Q

Cause of marrow failure

A

Cytopenia

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15
Q

myeloproliferative neoplasms

A

chronic leukemia

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16
Q

anabnormalmassoftissuethatformswhen cells grow and divide more than they should or do not die

A

Neoplasia

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17
Q

myelodysplastic neoplasms

A

refractory anemia

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17
Q

lymphoproliferative disorders

A

acute lymphoblastic
leukemia

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18
Q

plasma cell myeloma, macroglobulinemia, and metastatic tumors

A

immunoglobulin disorders

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19
Q

BONE MARROW SPECIMEN

bone marrow specimens are in the form of ______ / _____

A

aspirates or core biopsy

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20
Q

Consists of marrow and some boney spicules collected through Trephine biopsy

A

Core biopsy

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21
Q

demonstrates bone marrow architecture – the spatial relationship of hematological cells to fat cells, connective tissues and bony stroma

A

Core biopsy

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22
Q

used to estimate Cellularity

A

Core biopsy

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23
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Fast
No decalcification needed

A

Marrow Aspirate Smear

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24
Q

particularly important in the evaluation of disease that produce focal lesions

A

Core biopsy

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25
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Quantitation of cell type differential count

A

Marrow Aspirate Smear

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26
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Material for ancillary studies

A

Marrow Aspirate Smear

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27
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

May not represent all cells

A

Marrow Aspirate Smear

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28
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Dry tap in case of fibrosis or hypocellularity

A

Marrow Aspirate Smear

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29
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Does not represent BM architecture

A

Marrow Aspirate Smear

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30
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Inability to analyze the stroma

A

Marrow Aspirate Smear

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31
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Represents all cells

A

Marrow Core Biopsy

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31
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Analysis of both cells and stroma

A

Marrow Core Biopsy

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31
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Explains dry tap

A

Marrow Core Biopsy

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32
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Slow processing

A

Marrow Core Biopsy

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33
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Decalcification precludes certain ancillary studies

A

Marrow Core Biopsy

34
Q

MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY

Inability to perform quantitative differential count

A

Marrow Core Biopsy

35
Q

BONE MARROW COLLECTION SITES

This site can be used in adults as well as in children

A

Posterior Superior Iliac Crest

36
Q

BONE MARROW COLLECTION SITES

It provides an adequate amount of bone marrow and is isolated from other internal structures that can possibly injured during collection.

A

Posterior Superior Iliac Crest

37
Q

BONE MARROW COLLECTION SITES

Can be assigned for both Aspirate and Core Biopsy samples.

A

Posterior Superior Iliac Crest

38
Q

BONE MARROW COLLECTION SITES

Has the same advantages to the posterior superior iliac crest, but with a thicker cortical bone

A

Anterior Super Iliac Crest

39
Q

BONE MARROW COLLECTION SITES

Preferred site for patients who could only lie in the supine position

A

Anterior Super Iliac Crest

39
Q

BONE MARROW COLLECTION SITES

Just like iliac crests, it provides an ample amount of bone marrow, but since it is basically thin there may be a possibility of accidental piercing through the ______ that may cause damage to the heart and the great vessels of the heart.

40
Q

BONE MARROW COLLECTION SITES

Preferred site for children below 2 years of age

A

Anterior medial surface of tibia

41
Q

Seldom used, except when there is present of suspicious lesions as revealed by radiographic procedures

A

Spinous process of vertebra, ribs

42
Q

MATERIALS FOR BONE MARROW COLLECTION

T/F: Local anaesthetic is 1% lidocaine and should not exceed 20 mL per patient

43
Q

Needles used for bone marrow collection

A

Jamshidi Biopsy Needle / Westerman-Jensen Needle

44
Q

MATERIALS FOR BONE MARROW COLLECTION

provided with obturator, core biopsy tool and a stylet

A

Westerman-Jensen Needle & Jamshidi Biopsy Needle (disposable)

45
Q

MATERIALS FOR BONE MARROW COLLECTION

Has a coil mechanism at the middle tip that allows to
capture the bone marrow specimen without needle
redirection

46
Q

MATERIALS FOR BONE MARROW COLLECTION

Disposable 14 to 18 gauge aspiration needles with
obturator

A

Aspiration Needle

46
Q

is beneficial for obese patients, ventilator
patients, COPD patients as it is hard to approach form the back, cannot be turned prone, or hard sitting position

A

Anterior approach (Anterior Super Iliac Crest)

47
Q

Alternative to Direct Aspirate Smear

A

Anticoagulated Aspirate Smear

48
Q

Tube of anticoagulated aspirate smear

A

Lavender (EDTA)

49
Q
  • Mix with EDTA
  • Prepare smear from anticoagulated specimen
  • Distortion of cell morphology
A

Anticoagulated Aspirate Smear

50
Q
  • For bone marrow aspirate.
  • Petri dish/watch glass with EDTA
  • Bony spicules
  • Crush creating rectangular smears
  • 22% albumin
  • Cover slip
A

Crush Smear

51
Q

Recorded using the calibration in the wintrobe tube

A

Fat:ME Ratio

51
Q
  • Small number of nucleated cell
  • 1.5 mL of EDTA marrow is delivered to a Wintrobe tube which is then centrifuged.
  • After 10 minutes of centrifugation, four layers are produced
A

Concentrated (Buffy Coat) Smear

52
Q

Layer of Concentrated Smear

A

Fat
Plasma
Myeloid
RBCs

53
Q

This technique would compensate the hypocellular marrow
by allowing an examination of a larger number of cells

A

Crush Method

54
Q

T/F: Advantage of Concentrated Smear is the distortion of cell distribution

A

F; disadvantage

55
Q

Imprints (Touch Preparation) steps

A
  1. Core Biopsy
  2. Clotted marrow
  3. Dry Tap
56
Q

Fixatives used in bone marrow preservation

A

10% formalin
B5 fixative
Zenker glacial acetic acid

57
Q

is prepared after aspirate smears are done and aliquot of sample is saved for cytogenetic, molecular, and immunotypic studies

A

Cell Block

58
Q

STAINS

Aspirate smears

A

Wright or Wright-Giemsa

59
Q

STAINS

Aspirate and Core Biopsy

A

Prussian Blue

60
Q

STAINS

Especially for the estimation of the stored iron or iron
metabolism abnormalities

A

Prussian Blue

61
Q

CYTOCHEMICAL DYES

Myeloperoxidase (MPO) Sudan Black B (SBB)

A

Myelocytic Cells

61
Q

CYTOCHEMICAL DYES

Periodic Acid Schiff (PAS)

A

Lymphocytic and erythrocytic cells

62
Q

CYTOCHEMICAL DYES

Esterase

A

Myelocytic and monocytic cells

63
Q

CYTOCHEMICAL DYES

Tartrate-resistant acid phosphate

A

Hairy cell leukemia

64
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Hypocellular, normocellular or hypercellular classification based on the ratio of hematopoietic cells to adipocytes

A

Cellularity

65
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Narrative characterizing the maturation of myeloid and erythroid series

A

Maturation

66
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Estimate using LPO, compare with reference interval and comment on its morphology

A

Megakaryocytes

67
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Narrative describing number and morphology of eosinophils, basophils, mast cells, lymphocytes, plasma cells, monocytes, histiocytes with reference intervals

A

Additional Hematological Cells

68
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Narrative describing number and morphology of osteoblasts, osteoclasts, bony trabeculae, fibroblasts, adipocytes, and endothelial cells, appearance of sinuses, presence of amyloid, granulomas, fibrosis, and necrosis

A

Stromal Cells

69
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Categorization of findings as increased, normal, or decreased iron stores

A

Iron stores

69
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Number of all cells and cell stages observed after performing a differential count on 300- 1000 cells and comparing results with reference intervals

A

Differential count

69
Q

COMPONENTS OF A BONE MARROW EXAMINATION

Computed from nucleated hematological cells excluding lymphocyte, plasma cells, monocytes, and histiocytes

A

Myeloid-to- erythroid ratio (M:E)

70
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Bony spicules and clear cell morphology

70
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Assess peripheral blood dilution

71
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Fat:marrow ratio

72
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Myelocytic and erythrocytic maturation

73
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

  • Tumor cells clusters
  • Megakaryocytes
74
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Abnormal cell distribution and maturation stages

75
Q

Myeloid-to-erythroid ratio

A

1:5:1-3:3:1

75
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Differential count (300-1000)

76
Q

BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO

Myeloid:erythroid ratio

77
Q

DYES FOR BM CORE BIOPSY SPECIMEN

  • Most commonly used stain
  • Evaluate cellularity and hematopoietic stem cell distribution of the nucleated cells, locate abnormal cell clusters
A

H and E stain (Hematoxylin, Eosin)

78
Q

DYES FOR BM CORE BIOPSY SPECIMEN

Evaluate iron stores for deficiency or excess iron

A

Prussian blue iron stain

79
Q

DYES FOR BM CORE BIOPSY SPECIMEN

Examine for acid-fast bacilli, fungi, or bacteria on granulomatous disease

A

Acid-fast stain

79
Q

DYES FOR BM CORE BIOPSY SPECIMEN

Examine for marrow fibrosis

A

Reticulin and Trichrome stains

80
Q

DYES FOR BM CORE BIOPSY SPECIMEN

Establish the identity of malignant cells with stain-tagged monoclonal antibodies specific for tumor surface markers

A

Immunohistochemical stain

81
Q

DYES FOR BM CORE BIOPSY SPECIMEN

Examine for gram-positive or gram- negative bacteria

A

Gram stain

82
Q

DYES FOR BM CORE BIOPSY SPECIMEN

Observe hematopoietic cell structure

A

Wright or Wright- Giemsa stain

[MT 6318] Hematology Lecture (12 decks)

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