Bone marrow: Difference between revisions

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===Microscopic evaluation===

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.

*'''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.

*'''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'''

~~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==

*[[Flow cytometry]]

@@ Line 32: / Line 32: @@
 ===Microscopic evaluation===
 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.
 *'''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.
-*'''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'''
-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==
 *[[Flow cytometry]]
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Bone marrow: Difference between revisions

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