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Hematology > Ch. 16 Bone Marrow Examination > Flashcards

Ch. 16 Bone Marrow Examination Flashcards

1
Q

Collab bet. medtedch and a physician (hematologist or pathologist)

A

Bone marrow specimen collection

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2
Q

Collected, prior to bm collection, for a CBC w/ blood film exam

A

Peripheral Blood

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3
Q

Gelatinous and amenable to sampling

A

Red marrow

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4
Q

Composition of a Bone Marrow specimen

A

1) Aspirate

2) Core Biopsy Specimen

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5
Q

obtained by BM aspiration

A

aspirate

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6
Q

obtained by trephine biopsy

A

Core Biospy Specimen

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7
Q

examined to identify the types and PROPORTIONS OF HEMATOLOGIC CELLS and to look for MORPHOLOGIC VARIANCE

A

Aspirate

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8
Q

demonstrates BM architecture, spatial relatinshp of hematologic cells to fat, CT, bony strome

A

Core Biopsy Specimen

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9
Q

used to estimate CELLULARITY

A

Core Biopsy Specimen

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10
Q

particularly important for evaluating DISEASES that characteristically produce FOCAL LESIONS rather than diffuse involvement of marrow.

A

Core Biopsy specimen

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11
Q

diseases that produce predominantly FOCAL LESIONS

A
  1. Hodgkin lymphoma
  2. non-Hodgkin lymphoma
  3. multiple myeloma
  4. metastatic tumors
  5. amyloid
  6. granulomas
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12
Q

cell accumulations that contain Langerhans cells

A

Granulomas or Granulomatic Lesions

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13
Q

are large, activated granular macrophages that look like epithelial cells

A

Langerhans Cells

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14
Q

Granulomas signal _____ infection

A

Chronic infection

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15
Q

Biopsy Sx allows morphologic evaluation of bony spicules, which may reveal changes associated with ____

A

hyperparathyroidism or Paget disease

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16
Q

this site of BM collection provides adequate red marroow that is isolated from anaomic structures wc are subject to INJURY

A

Posterior superior iliac crest

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17
Q

same as post. iliac crest but cortical bone is THICKER

A

Anterior iliac crest

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18
Q

BM site used for BOTH aspirate and core biopsy

A

Posterior iliac crest

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19
Q

BM site used for a patient who can ONLY lie SUPINE

A

Anterior iliac crest

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20
Q

below the angle of Lewis at 2nd intercostal space
This provides AMPLE material for Aspiration
Can accidentally damage the heart or great vessels if needle enters the PERICARDIUM

A

Sternum

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21
Q

only 1 cm thick and cannot be used for core biopsy

A

Sternum

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22
Q

BM site for CHILDREN younger than age 2

A

Anterior medial surface of the tibia

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23
Q

BM sites that are RARELY used unless they are the site of a suspicious LESION discovered on radiograph

A

Spinous process of the vertebrae, ribs or other Red Marrow containing bones

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24
Q

most common side effect to anesthetics during BM collection

A

Hemorrhage associated with thrombocytopenia

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25
Q

When does the medtech collects VENOUS PERIPHERAL BLOOD prior to bone marrow collection

A

Less than 24 hrs

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26
Q

Effect on WBC count if peripheral blood is collected after BM collection

A

elevated (stress)

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27
Q

Usual local anesthetic injection

A

1% lidocaine (not to exceed 20 mL per patient)

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28
Q

blade used for skin incision

A

No. 11 scalpel blade

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29
Q

Disposable needles that provide an OBTURATOR, CORE BIOPSY TOOL, and STYLET

A

1) Jamshidi biopsy needle

2) Westerman-Jensen needle

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30
Q

Biospy needle that has a COIL MECHANISM at the needle tip which allows capture of BM Sx without needle redirection

A

Snarecoil needle

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31
Q

gauge of BM aspiration needle

A

14-18

32
Q

provided to prevent penetration of the sternum to the pericardium

A

Flange

33
Q

fixative used in BM collection

A

Zenker fixative

34
Q

Position of Patient during BM collection

A

Pt. lies in a supine position, prone, or in a decubitus position

35
Q

what part of bone surface is the papule located

A

Periousteum

36
Q

mm of skin incision over the puncture site

A

3-mm

37
Q

Which specimen is usually collected first to prevent destruction of marrow architecture

A

Core Biopsy Specime

38
Q

this part of the needle prevents coring of the skin or bone

A

Obturator

39
Q

Where is the needle pentrated

A

through the Cortex to the medulla

40
Q

dislodges the core cylinder (where the Sx is located) after BM core biopsy collection

A

stylus

41
Q

Jamshidi needle parts

A

1) outer cannula
2) obturator
3) biopsy needle
4) core cylinder
5) stylus

42
Q

Westerman-Jensen needle parts:

A

1) needle/ outrer cannula
2) obturator
3) cutting blades

43
Q

Aspirating more than 1.5 mL dilutes the hematopoietic marrow with

A

sinusoidal (peripheral) blood

should only collect 1-1.5mL

44
Q

Term used if there’s Unsuccessful aspiration bc the marrow is FIBROTIC, acellular, or packed with Leukemic cells

A

Dry Tap

45
Q

this is applied to the patient while he remains in the same position for 1 hr to prevent bleeding

A

Pressure Dressing

46
Q

More spicules recovered in the blood smear meaning _____.

Few fat globules or spicules meaning _____.

A

More cells to identify and categorize.

Physician to collect an additional specimen.

47
Q

These specimens are more leisurely alternative to direct aspirate smears

A

Anticoagulated specimens

48
Q

anticoagulant used with Aspirate smears. It generates the least distortion of cell morphology.

A

K3EDTA

49
Q

What is added after crush smearing and the Sx is suspected to contain POLYLYMPHOCTES or LYMPHOBLASTS which tend to rupture

A

22% albumin

50
Q

reduces the occurrence of “smudge” or “basket” cells often seen in lymphoid marrow lesions

A

Albumin

51
Q

This crush preparation procedure method yields better MORPHOLOGIC INFORMATION bc theres less cell rupture during separation

A

Cover-slip method

52
Q

Used in automated staining after smearing

A

Glass slide method

53
Q

Crush smear prep where smear must be affixed side up to slide first and then stained manually

A

COVERSLIP PREPARATION

54
Q

The cell morphology of these preparations may imitate aspirate morphology.
They are valuable when the specimen has clotted or theres a dry tap.

A

Imprint or Touch Preparationos

55
Q

smears that are useful when there are sparse NUCLEATED CELLS in the direct marrow smear or when the number of nucleated cells is anticipated to be small, like APLASTIC ANEMIA

A

Concentrate or Buffy coat smears

56
Q

1st layer in Wintrobe tube after centrifugation

A

Yellowish fat (1-3% of Wintrobe column)

57
Q

2nd Layer in Wintrobe tube after centriguation

A

Plasma

58
Q

3rd layer in Wintrobe tube after centriguation

A

Nucleated cells or “MYELOID-ERYTHROID LAYER” (ME Layer)

normally 5-8% of total column

59
Q

4th/ Bottom Layer in Wintrobe tube after centriguation

A

Red Blood Cells

60
Q

recorded using mm graduations on Wintrobe tube

A

fat/ME layer ratio

61
Q

portion of ME layer + portion of plasma&raquo_space; in a Petri dish/watch glass =

A

Concentrate (buffy coat) smear

62
Q

This smear compensates for hypocellular marrow and allows for examination of large numbers of nucleated cells without interference from FAT and RBCs

A

Concentrate (buffy coat) smear

63
Q

This procedure destroys cell distribution. thus, DO NOT estimate nos. of diff. cell types or maturation stages on this smear

A

Concentrate (buffy coat) smear

64
Q

Where the remaining core bioppsy specimens, spicules or clottes sx are submitted to after aspirates mears are prepared

A

HISTOLOGIC SECTIONS (Cell Block)

65
Q

In histologic exam, the specimen is suuspended in _____ fixative for 2 hours

A

10% formalin or
Zenker glacial HAc or
B5 fixative

66
Q

IIn histologic exam, what dyes are used after sectioning the embedded specimen

A

Hematoxylin & Eosin (H&E) dye

67
Q

Marrow Aspirate Smear dyes used

A

Wright or Wright Giemsa dyes

68
Q

In this smear prep, there’s Increased staining time because thicker smear than Peripheral Blood Smear

A

Marrow Aspirate Smear

69
Q

Stain that can be used for MARROW ASPIRATE SMEARS and CORE BIOPSY SPECIMENS to detect and estimate MARROW STORAGE IRON or IRON METABOLISM ABNORMALITIES

A

Ferric Ferricyanide (Prussian blue)

70
Q

Cytochemical Dye used to detect MYELOCYTIC CELLS by staining CYTOPLASMIC GRANULAR CONTENTS

A

1) Myeloperoxidase (MPO)

2) Sudan Black B (SBB)

71
Q

Cytochemical Dye used to detect LYMPHOCYTIC CELLS and certain ABNORMAL ERYHTROCYTIC CELLS by staining of CYTOPLASMIC GLYCOGEN

A

Periodic acid Schiff (PAS)

72
Q

Cytochemical Dye used to distinguish MYELOCYTIC from MONOCYTIC MATURATION STAGES (several ESTERASE substrates)

A

Esterases

73
Q

Cytochemical Dye used to detect TARTRATE-RESISTANT ACID PHOSPHATASE GRANULES in HAIRY CELL LEUKEMIA

A

Tartrate-resistant acid phosphatase (TRAP)

74
Q

(BM Aspirate Microscopic smear exam) PROCEDURES IN LOW POWER: 10x Obj

A

PeBoRaTuMe

1) Assess PERIPHERAL BLOOD DILUTION
2) Find BONY SPICULES and areas of CLEAR cell MORPHOLOGY
3) Observe fat-to-marrow RATIO, estimate CELLULARITY
4) Search for TUMOR cells in Clusters
5) Examine and estimate MEGAKARYOCYTES

75
Q

(BM Aspirate Microscopic smear exam) PROCEDURES IN HIGH POWER: 10x Obj

A

MemAbMaDiffME

1) observe MYELOCYTIC and ERYTHROCYTIC MATURATION
2) distinguish ABN. DISTRIBUTION OF CELLS or CELL MATURATION STAGES
3) perform DIFF COUNT on 300-1000 cells
4) compute MYELOID-ERYTHROID RATIO (M:E)

Hematology (7 decks)

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