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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
demonstrates bone marrow architecture – the spatial relationship of hematological cells to fat cells, connective tissues and bony stroma
Core biopsy
22
used to estimate Cellularity
Core biopsy
23
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Fast No decalcification needed
Marrow Aspirate Smear
24
particularly important in the evaluation of disease that produce focal lesions
Core biopsy
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MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Quantitation of cell type differential count
Marrow Aspirate Smear
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MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Material for ancillary studies
Marrow Aspirate Smear
27
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY May not represent all cells
Marrow Aspirate Smear
28
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Dry tap in case of fibrosis or hypocellularity
Marrow Aspirate Smear
29
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Does not represent BM architecture
Marrow Aspirate Smear
30
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Inability to analyze the stroma
Marrow Aspirate Smear
31
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Represents all cells
Marrow Core Biopsy
31
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Analysis of both cells and stroma
Marrow Core Biopsy
31
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Explains dry tap
Marrow Core Biopsy
32
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Slow processing
Marrow Core Biopsy
33
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Decalcification precludes certain ancillary studies
Marrow Core Biopsy
34
MARROW ASPIRATE SMEAR AND MARROW CORE BIOPSY Inability to perform quantitative differential count
Marrow Core Biopsy
35
BONE MARROW COLLECTION SITES This site can be used in adults as well as in children
Posterior Superior Iliac Crest
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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.
Posterior Superior Iliac Crest
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BONE MARROW COLLECTION SITES Can be assigned for both Aspirate and Core Biopsy samples.
Posterior Superior Iliac Crest
38
BONE MARROW COLLECTION SITES Has the same advantages to the posterior superior iliac crest, but with a thicker cortical bone
Anterior Super Iliac Crest
39
BONE MARROW COLLECTION SITES Preferred site for patients who could only lie in the supine position
Anterior Super Iliac Crest
39
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.
sternum
40
BONE MARROW COLLECTION SITES Preferred site for children below 2 years of age
Anterior medial surface of tibia
41
Seldom used, except when there is present of suspicious lesions as revealed by radiographic procedures
Spinous process of vertebra, ribs
42
MATERIALS FOR BONE MARROW COLLECTION T/F: Local anaesthetic is 1% lidocaine and should not exceed 20 mL per patient
T
43
Needles used for bone marrow collection
Jamshidi Biopsy Needle / Westerman-Jensen Needle
44
MATERIALS FOR BONE MARROW COLLECTION provided with obturator, core biopsy tool and a stylet
Westerman-Jensen Needle & Jamshidi Biopsy Needle (disposable)
45
MATERIALS FOR BONE MARROW COLLECTION Has a coil mechanism at the middle tip that allows to capture the bone marrow specimen without needle redirection
Snarecoil
46
MATERIALS FOR BONE MARROW COLLECTION Disposable 14 to 18 gauge aspiration needles with obturator
Aspiration Needle
46
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
Anterior approach (Anterior Super Iliac Crest)
47
Alternative to Direct Aspirate Smear
Anticoagulated Aspirate Smear
48
Tube of anticoagulated aspirate smear
Lavender (EDTA)
49
- Mix with EDTA - Prepare smear from anticoagulated specimen - Distortion of cell morphology
Anticoagulated Aspirate Smear
50
- For bone marrow aspirate. - Petri dish/watch glass with EDTA - Bony spicules - Crush creating rectangular smears - 22% albumin - Cover slip
Crush Smear
51
Recorded using the calibration in the wintrobe tube
Fat:ME Ratio
51
- 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
Concentrated (Buffy Coat) Smear
52
Layer of Concentrated Smear
Fat Plasma Myeloid RBCs
53
This technique would compensate the hypocellular marrow by allowing an examination of a larger number of cells
Crush Method
54
T/F: Advantage of Concentrated Smear is the distortion of cell distribution
F; disadvantage
55
Imprints (Touch Preparation) steps
1. Core Biopsy 2. Clotted marrow 3. Dry Tap
56
Fixatives used in bone marrow preservation
10% formalin B5 fixative Zenker glacial acetic acid
57
is prepared after aspirate smears are done and aliquot of sample is saved for cytogenetic, molecular, and immunotypic studies
Cell Block
58
STAINS Aspirate smears
Wright or Wright-Giemsa
59
STAINS Aspirate and Core Biopsy
Prussian Blue
60
STAINS Especially for the estimation of the stored iron or iron metabolism abnormalities
Prussian Blue
61
CYTOCHEMICAL DYES Myeloperoxidase (MPO) Sudan Black B (SBB)
Myelocytic Cells
61
CYTOCHEMICAL DYES Periodic Acid Schiff (PAS)
Lymphocytic and erythrocytic cells
62
CYTOCHEMICAL DYES Esterase
Myelocytic and monocytic cells
63
CYTOCHEMICAL DYES Tartrate-resistant acid phosphate
Hairy cell leukemia
64
COMPONENTS OF A BONE MARROW EXAMINATION Hypocellular, normocellular or hypercellular classification based on the ratio of hematopoietic cells to adipocytes
Cellularity
65
COMPONENTS OF A BONE MARROW EXAMINATION Narrative characterizing the maturation of myeloid and erythroid series
Maturation
66
COMPONENTS OF A BONE MARROW EXAMINATION Estimate using LPO, compare with reference interval and comment on its morphology
Megakaryocytes
67
COMPONENTS OF A BONE MARROW EXAMINATION Narrative describing number and morphology of eosinophils, basophils, mast cells, lymphocytes, plasma cells, monocytes, histiocytes with reference intervals
Additional Hematological Cells
68
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
Stromal Cells
69
COMPONENTS OF A BONE MARROW EXAMINATION Categorization of findings as increased, normal, or decreased iron stores
Iron stores
69
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
Differential count
69
COMPONENTS OF A BONE MARROW EXAMINATION Computed from nucleated hematological cells excluding lymphocyte, plasma cells, monocytes, and histiocytes
Myeloid-to- erythroid ratio (M:E)
70
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Bony spicules and clear cell morphology
LPO
70
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Assess peripheral blood dilution
LPO
71
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Fat:marrow ratio
LPO
72
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Myelocytic and erythrocytic maturation
HPO
73
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO - Tumor cells clusters - Megakaryocytes
LPO
74
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Abnormal cell distribution and maturation stages
HPO
75
Myeloid-to-erythroid ratio
1:5:1-3:3:1
75
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Differential count (300-1000)
HPO
76
BM ASPIRATE OR IMPRINT EXAMINATION: HPO/LPO Myeloid:erythroid ratio
HPO
77
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
H and E stain (Hematoxylin, Eosin)
78
DYES FOR BM CORE BIOPSY SPECIMEN Evaluate iron stores for deficiency or excess iron
Prussian blue iron stain
79
DYES FOR BM CORE BIOPSY SPECIMEN Examine for acid-fast bacilli, fungi, or bacteria on granulomatous disease
Acid-fast stain
79
DYES FOR BM CORE BIOPSY SPECIMEN Examine for marrow fibrosis
Reticulin and Trichrome stains
80
DYES FOR BM CORE BIOPSY SPECIMEN Establish the identity of malignant cells with stain-tagged monoclonal antibodies specific for tumor surface markers
Immunohistochemical stain
81
DYES FOR BM CORE BIOPSY SPECIMEN Examine for gram-positive or gram- negative bacteria
Gram stain
82
DYES FOR BM CORE BIOPSY SPECIMEN Observe hematopoietic cell structure
Wright or Wright- Giemsa stain

[MT 6318] Hematology Lecture (12 decks)

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