Bone marrow - Revision history

Mikael Häggström: /* Microscopic report */ Columns

2022-07-28T22:28:00Z

Microscopic report: Columns

← Older revision		Revision as of 18:28, 28 July 2022
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	PERIPHERAL SMEAR:		PERIPHERAL SMEAR:

			{{col-begin\|width=95%}}
			\|-
			\|
	:WBC:__ x103/ul		:WBC:__ x103/ul
	:RBC:__ x106/ul		:RBC:__ x106/ul
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	:PLT:__ x103/ul		:PLT:__ x103/ul
	:RETIC:__ %		:RETIC:__ %
			\|
	DIFFERENTIAL(%):		DIFFERENTIAL(%):
	:NEUTR/BANDS:_		:NEUTR/BANDS:_
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	:METAS:_		:METAS:_
	:NRBCS/100WBCS:_		:NRBCS/100WBCS:_
	:PLASMA CELLS:_		:PLASMA CELLS:_
			\|}
	MORPHOLOGY:		MORPHOLOGY:
	*Red Blood Cells: No significant abnormality.		*Red Blood Cells: No significant abnormality.
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	\|}		\|}
	<noinclude>		<noinclude>

	==See also==		==See also==
	*[[Flow cytometry]]		*[[Flow cytometry]]
	{{Bottom}}		{{Bottom}}
	</noinclude>		</noinclude>

Mikael Häggström:

2022-06-19T19:13:01Z

← Older revision		Revision as of 15:13, 19 June 2022
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	:All stains have functional controls.		:All stains have functional controls.
	\|}		\|}
			<noinclude>
	==See also==		==See also==
	*[[Flow cytometry]]		*[[Flow cytometry]]
	{{Bottom}}		{{Bottom}}
			</noinclude>

Mikael Häggström: header

2022-01-22T21:52:42Z

header

← Older revision		Revision as of 17:52, 22 January 2022
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	Example template:		Example template:

	{{Comprehensiveness\|otherlegend=yes}}		{{Comprehensiveness\|otherlegend=yes\|noheader=yes}}
	{\|class=wikitable		{\|class=wikitable
	\|		\|

Mikael Häggström: /* Bone marrow biopsy */ +Report

2022-01-22T21:50:59Z

Bone marrow biopsy: +Report

@@ Line 50: / Line 50: @@
 *'''Reticulin''' to grade the amount of fibrosis.
 *'''CD3''' and '''CD20''' to highlight T and B cells, respectively.
 ==See also==
 *[[Flow cytometry]]
 {{Bottom}}

Mikael Häggström: /* Gross processing */ Wording

2022-01-22T21:32:38Z

Gross processing: Wording

← Older revision		Revision as of 17:32, 22 January 2022
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	*If the biopsy is received in a zinc-containing fixative, '''rinse''' it for about 2 minutes, such as placing the cassette in a container under running water (and block any sink enough so that the cassette won't float away).		*If the biopsy is received in a zinc-containing fixative, '''rinse''' it for about 2 minutes, such as placing the cassette in a container under running water (and block any sink enough so that the cassette won't float away).
	[[File:Histopathology of bone marrow with insufficient decalcification.jpg\|thumb\|200px\|Histopathology of bone marrow with '''insufficient decalcification''', wherein the bony trabeculae may get pushed by the microtome blade and plow away the cells of interest as displayed. To compensate, thicker sections may be taken, also making evaluation harder.]]		[[File:Histopathology of bone marrow with insufficient decalcification.jpg\|thumb\|200px\|Histopathology of bone marrow with '''insufficient decalcification''', wherein the bony trabeculae may get pushed by the microtome blade and plow away the cells of interest as displayed. To compensate, thicker sections may be taken, also making evaluation harder.]]
	*Put in '''decalcifying''' solution, ~~generally~~ about 15 minutes, and palpate the specimen to check whether it is still firm. If it is, decalcify another 5-10 minutes and check again. Rather have it a little bit too soft than a little bit too firm. Be careful to follow grossing guidelines for bone marrows, since even a small aberration in the processing is likely to be noticed as creating artifacts.		*Put in '''decalcifying''' solution, preferably using a type that is optimal for performing subsequent immunohistochemistry. Generally decalcify the specimen for about 15 minutes initially, and palpate the specimen to check whether it is still firm. If it is, decalcify another 5-10 minutes and check again. Rather have it a little bit too soft than a little bit too firm. Be careful to follow grossing guidelines for bone marrows, since even a small aberration in the processing is likely to be noticed as creating artifacts.

	;Gross report example:		;Gross report example:

Mikael Häggström: /* Gross processing */ '''

2022-01-22T21:29:18Z

Gross processing: '''

← Older revision		Revision as of 17:29, 22 January 2022
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	*'''Measure''' length and diameter of each fragment.		*'''Measure''' length and diameter of each fragment.
	*If the biopsy is received in a zinc-containing fixative, '''rinse''' it for about 2 minutes, such as placing the cassette in a container under running water (and block any sink enough so that the cassette won't float away).		*If the biopsy is received in a zinc-containing fixative, '''rinse''' it for about 2 minutes, such as placing the cassette in a container under running water (and block any sink enough so that the cassette won't float away).
	[[File:Histopathology of bone marrow with insufficient decalcification.jpg\|thumb\|200px\|Histopathology of bone marrow with insufficient decalcification, wherein the bony trabeculae may get pushed by the microtome blade and plow away the cells of interest as displayed. To compensate, thicker sections may be taken, also making evaluation harder.]]		[[File:Histopathology of bone marrow with insufficient decalcification.jpg\|thumb\|200px\|Histopathology of bone marrow with '''insufficient decalcification''', wherein the bony trabeculae may get pushed by the microtome blade and plow away the cells of interest as displayed. To compensate, thicker sections may be taken, also making evaluation harder.]]
	*Put in '''decalcifying''' solution, generally about 15 minutes, and palpate the specimen to check whether it is still firm. If it is, decalcify another 5-10 minutes and check again. Rather have it a little bit too soft than a little bit too firm. Be careful to follow grossing guidelines for bone marrows, since even a small aberration in the processing is likely to be noticed as creating artifacts.		*Put in '''decalcifying''' solution, generally about 15 minutes, and palpate the specimen to check whether it is still firm. If it is, decalcify another 5-10 minutes and check again. Rather have it a little bit too soft than a little bit too firm. Be careful to follow grossing guidelines for bone marrows, since even a small aberration in the processing is likely to be noticed as creating artifacts.

Mikael Häggström: /* Gross processing */ +Insufficient

2022-01-22T21:28:51Z

Gross processing: +Insufficient

← Older revision		Revision as of 17:28, 22 January 2022
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	*'''Measure''' length and diameter of each fragment.		*'''Measure''' length and diameter of each fragment.
	*If the biopsy is received in a zinc-containing fixative, '''rinse''' it for about 2 minutes, such as placing the cassette in a container under running water (and block any sink enough so that the cassette won't float away).		*If the biopsy is received in a zinc-containing fixative, '''rinse''' it for about 2 minutes, such as placing the cassette in a container under running water (and block any sink enough so that the cassette won't float away).
			[[File:Histopathology of bone marrow with insufficient decalcification.jpg\|thumb\|200px\|Histopathology of bone marrow with insufficient decalcification, wherein the bony trabeculae may get pushed by the microtome blade and plow away the cells of interest as displayed. To compensate, thicker sections may be taken, also making evaluation harder.]]
	*Put in '''decalcifying''' solution, generally about 15 minutes, and palpate the specimen to check whether it is still firm. If it is, decalcify another 5-10 minutes and check again. Rather have it a little bit too soft than a little bit too firm. Be careful to follow grossing guidelines for bone marrows, since even a small aberration in the processing is likely to be noticed as creating artifacts.		*Put in '''decalcifying''' solution, generally about 15 minutes, and palpate the specimen to check whether it is still firm. If it is, decalcify another 5-10 minutes and check again. Rather have it a little bit too soft than a little bit too firm. Be careful to follow grossing guidelines for bone marrows, since even a small aberration in the processing is likely to be noticed as creating artifacts.

Mikael Häggström: /* Autopsy */ Collection

2022-01-22T18:06:13Z

Autopsy: Collection

← Older revision		Revision as of 14:06, 22 January 2022
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	[[File:Trilineage hematopoiesis, annotated.jpg\|thumb\|Bone marrow aspirate showing normal "trilineage hematopoiesis":<br>- '''Myelomonocytic''' cells: an eosinophil myelocyte marked<br>- '''Erythroid''' cells: an orthochromatic erythroblast marked<br>- '''Megakaryocytic''' cells.]]		[[File:Trilineage hematopoiesis, annotated.jpg\|thumb\|Bone marrow aspirate showing normal "trilineage hematopoiesis":<br>- '''Myelomonocytic''' cells: an eosinophil myelocyte marked<br>- '''Erythroid''' cells: an orthochromatic erythroblast marked<br>- '''Megakaryocytic''' cells.]]
	==Autopsy==		==Autopsy==
			Using pliers or similar tool, squeeze some bone marrow from a rib.

	===Microscopic evaluation===		===Microscopic evaluation===
	*Confirm trilineage hematopoiesis (see image).		*Confirm trilineage hematopoiesis (see image).

Mikael Häggström: Organized

2022-01-22T18:03:33Z

Organized

← Older revision		Revision as of 14:03, 22 January 2022
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	\| '''Bone marrow''' from rib (or other location if applicable): Trilineage hematopoiesis. There is no evidence of malignancy.		\| '''Bone marrow''' from rib (or other location if applicable): Trilineage hematopoiesis. There is no evidence of malignancy.
	\|}		\|}

	~~==Bone marrow aspirate==~~
	Find a location where bone marrow cells can be seen individually, preferably with minimal peripheral blood among them. Sometimes it is between trabeculae and sometimes it is in the surrounding area. Perform a '''differential count''' by counting 500 cells<ref name="pmid29757362">{{cite journal\| author=Abdulrahman AA, Patel KH, Yang T, Koch DD, Sivers SM, Smith GH \| display-authors=etal\| title=Is a 500-Cell Count Necessary for Bone Marrow Differentials?: A Proposed Analytical Method for Validating a Lower Cutoff. \| journal=Am J Clin Pathol \| year= 2018 \| volume= 150 \| issue= 1 \| pages= 84-91 \| pmid=29757362 \| doi=10.1093/ajcp/aqy034 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29757362 }} </ref> and dividing the numbers by 5 to get their percentages. Don't count cells that don't have a cytoplasm or nucleus. If you receive several slides, count about the same number of cells from each slide, but don't count cells from slides where the cell types are more indistinct.

	==Bone marrow biopsy==		==Bone marrow biopsy==
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	;Bone marrow aspirate		;Bone marrow aspirate
			Find a location where bone marrow cells can be seen individually, preferably with minimal peripheral blood among them. Sometimes it is between trabeculae and sometimes it is in the surrounding area. Perform a '''differential count''' by counting 500 cells<ref name="pmid29757362">{{cite journal\| author=Abdulrahman AA, Patel KH, Yang T, Koch DD, Sivers SM, Smith GH \| display-authors=etal\| title=Is a 500-Cell Count Necessary for Bone Marrow Differentials?: A Proposed Analytical Method for Validating a Lower Cutoff. \| journal=Am J Clin Pathol \| year= 2018 \| volume= 150 \| issue= 1 \| pages= 84-91 \| pmid=29757362 \| doi=10.1093/ajcp/aqy034 \| pmc= \| url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29757362 }} </ref> and dividing the numbers by 5 to get their percentages. Don't count cells that don't have a cytoplasm or nucleus. If you receive several slides, count about the same number of cells from each slide, but don't count cells from slides where the cell types are more indistinct.
	*'''Myeloid/erythroid ratio''', usually defined as the ratio between the number of neutrophil granulocytes and precursors versus the number of erythroblasts. Depending on source, the lower limit of the normal range for this ratio bone marrow aspirate smears in adults is 1 to 2, and the upper limit is 5 to 8.<ref name=Medicalkey>{{cite web\|title=Chapter 5: Pathology of the marrow\|url=https://basicmedicalkey.com/pathology-of-the-marrow-general-considerations-and-infectionsreactive-conditions/\|website=Basicmedical Key\|author=BJ. Bain\|date=2017-02-19}}</ref> In histologic sections, the normal range is 1.5 – 3.0.<ref name=Medicalkey/> Some hematologists also include eosinophils, basophils and monocytes, as well as their precursors, in the myeloid number, but this has only a minor effect on the M:E ratio in normal individuals.<ref name=Medicalkey/> Still, if you are to calculate the value for a senior, check their preference first.		*'''Myeloid/erythroid ratio''', usually defined as the ratio between the number of neutrophil granulocytes and precursors versus the number of erythroblasts. Depending on source, the lower limit of the normal range for this ratio bone marrow aspirate smears in adults is 1 to 2, and the upper limit is 5 to 8.<ref name=Medicalkey>{{cite web\|title=Chapter 5: Pathology of the marrow\|url=https://basicmedicalkey.com/pathology-of-the-marrow-general-considerations-and-infectionsreactive-conditions/\|website=Basicmedical Key\|author=BJ. Bain\|date=2017-02-19}}</ref> In histologic sections, the normal range is 1.5 – 3.0.<ref name=Medicalkey/> Some hematologists also include eosinophils, basophils and monocytes, as well as their precursors, in the myeloid number, but this has only a minor effect on the M:E ratio in normal individuals.<ref name=Medicalkey/> Still, if you are to calculate the value for a senior, check their preference first.
	In a bone marrow count, '''nucleated red blood cells''' count into the total percentage of cells (but does not count into percentage of white blood cells in peripheral blood).		In a bone marrow count, '''nucleated red blood cells''' count into the total percentage of cells (but does not count into percentage of white blood cells in peripheral blood).

Mikael Häggström: /* Microscopic evaluation */ +Image

2022-01-22T18:01:42Z

Microscopic evaluation: +Image

← Older revision		Revision as of 14:01, 22 January 2022
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	===Microscopic evaluation===		===Microscopic evaluation===
	Evaluate the following:		Evaluate the following:

			;Bone marrow aspirate
			*'''Myeloid/erythroid ratio''', usually defined as the ratio between the number of neutrophil granulocytes and precursors versus the number of erythroblasts. Depending on source, the lower limit of the normal range for this ratio bone marrow aspirate smears in adults is 1 to 2, and the upper limit is 5 to 8.<ref name=Medicalkey>{{cite web\|title=Chapter 5: Pathology of the marrow\|url=https://basicmedicalkey.com/pathology-of-the-marrow-general-considerations-and-infectionsreactive-conditions/\|website=Basicmedical Key\|author=BJ. Bain\|date=2017-02-19}}</ref> In histologic sections, the normal range is 1.5 – 3.0.<ref name=Medicalkey/> Some hematologists also include eosinophils, basophils and monocytes, as well as their precursors, in the myeloid number, but this has only a minor effect on the M:E ratio in normal individuals.<ref name=Medicalkey/> Still, if you are to calculate the value for a senior, check their preference first.
			In a bone marrow count, '''nucleated red blood cells''' count into the total percentage of cells (but does not count into percentage of white blood cells in peripheral blood).

			;Bone marrow biopsy, H&E stain
	*'''Adequacy''': There should preferably be 5 intertrabecular spaces.		*'''Adequacy''': There should preferably be 5 intertrabecular spaces.
	*'''Cellularity''': This is a rather rough estimation of the area of hematopoietic cells divided by the area of all intertrabecular matter, which otherwise mainly consists of fat cells and a small interstitial space. Areas of bone, hemorrhage or artifacts are not counted. In patients 20-80 years, the percentage should be about 100 minus age, such as 40% in a 60 year old patient.		*'''Cellularity''': This is a rather rough estimation of the area of hematopoietic cells divided by the area of all intertrabecular matter, which otherwise mainly consists of fat cells and a small interstitial space. Areas of bone, hemorrhage or artifacts are not counted. In patients 20-80 years, the percentage should be about 100 minus age, such as 40% in a 60 year old patient.
	*'''Thrombopoiesis''': There are normally about 3 megakaryocytes per 40x field.		*'''Thrombopoiesis''': There are normally about 3 megakaryocytes per 40x field.
	*'''Myeloid/erythroid ratio''', usually defined as the ratio between the number of neutrophil granulocytes and precursors versus the number of erythroblasts. Depending on source, the lower limit of the normal range for this ratio bone marrow aspirate smears in adults is 1 to 2, and the upper limit is 5 to 8.<ref name=Medicalkey>{{cite web\|title=Chapter 5: Pathology of the marrow\|url=https://basicmedicalkey.com/pathology-of-the-marrow-general-considerations-and-infectionsreactive-conditions/\|website=Basicmedical Key\|author=BJ. Bain\|date=2017-02-19}}</ref> In histologic sections, the normal range is 1.5 – 3.0.<ref name=Medicalkey/> Some hematologists also include eosinophils, basophils and monocytes, as well as their precursors, in the myeloid number, but this has only a minor effect on the M:E ratio in normal individuals.<ref name=Medicalkey/> Still, if you are to calculate the value for a senior, check their preference first.
	*Look for any '''granuloma''' or '''cancer metastasis'''		*Look for any '''granuloma''' or '''cancer metastasis'''

	~~In a bone~~ marrow ~~count~~, '''~~nucleated red blood cells~~''' ~~count into~~ the ~~total percentage~~ of cells ~~(but does not count into percentage~~ of ~~white blood~~ cells ~~in peripheral blood)~~.		;Bone marrow biopsy, other stains
			Generally including:
			[[File:Ring sideroblast.jpg\|thumb\|210px\|Ring '''sideroblast''', defined by five or more perinuclear iron granules that encompass at least 1/3 of the nuclear circumference.<ref>Salama M, Teruya-Feldstein J, Kremyankaya M. Atlas of Diagnostic Hematology. Philadelphia, PA: Elsevier; 2021.</ref>]]
			*'''Iron stain''': Look at approximately 100 cells and semi-quantify the presence of any ring sideroblasts.
			*'''Reticulin''' to grade the amount of fibrosis.
			*'''CD3''' and '''CD20''' to highlight T and B cells, respectively.

	==See also==		==See also==
	*[[Flow cytometry]]		*[[Flow cytometry]]
	{{Bottom}}		{{Bottom}}