1、1cell morphology)hemopoietic stem cell)cytogenetics)tiology)Lupus erythematosus cellObjective of Examination of Bone Marrow2Approachs to Morphology of Bone Marrow 普通光学显微镜(Light microscope)10X10 10X1003malignant histiocytosis,multiple myeloma,aplastic anemia,megaloblastic anemia,cancer metastasis to
2、bone marrow plasmodium;Leishmania etc.(Clinical Application of the Bone Marrow Examination)4thrombocytopenia;myelodysplastic syndroms polycythemia vera;Myelofibrosis5ndifferential diagnosis:Fever of unknow origin;Swelling of lymph nodes or liver or spleen;leukemoid reaction;eosinophilia6malignant hi
3、stiocytosis;cancer metastasis to bone marrow;chronic aplastic anemia;myeloma etc.Considerations in Application7 Myelofibrosis;some types of leukemia;myelodysplastic syndroms;aplastic anemia89Development Pattern and Normal Morphology10全能干细胞全能干细胞淋巴系干细胞淋巴系干细胞T淋巴系祖细胞淋巴系祖细胞-形态可辨认细胞形态可辨认细胞B淋巴系祖细胞淋巴系祖细胞-形态
4、可辨认细胞形态可辨认细胞骨髓系干细胞骨髓系干细胞红系祖细胞红系祖细胞-形态可辨认细胞形态可辨认细胞粒粒-单核系祖细胞单核系祖细胞-形态可辨认细形态可辨认细胞胞嗜酸粒祖细胞嗜酸粒祖细胞-形态可辨认细胞形态可辨认细胞嗜碱粒祖细胞嗜碱粒祖细胞-形态可辨认细胞形态可辨认细胞巨核系祖细胞巨核系祖细胞-形态可辨认细胞形态可辨认细胞11血细胞发育过程中形态学演变的一般规律血细胞发育过程中形态学演变的一般规律12nucleo-cytoplasmic ratio)13nucleus)14ytoplasm)15Morphology of Normal Hemocytes(erythron)16(erythron)
5、胞体由大变小,始终呈圆形核保持圆形，渐缩小，固缩，后脱核，成熟红细胞无 核;染色质结构由细致疏松逐渐变为紧密粗糙.核仁由清晰到消失浆由深蓝或浅蓝变为浅红由少渐多17(granulocytes)18胞体由大变小早幼粒细胞可比原粒细胞稍大圆形或椭圆形粒系胞核一侧渐凹陷，后成分叶状染色质结构由细致疏松逐渐变为紧密粗糙核仁由清晰到消失由嗜碱变为嗜酸,颗粒由无到有(granulocytes)19(lymphocyte)20lymphocytes)胞体保持圆形或椭圆形核呈圆或椭圆形，染色质结构由细致疏松逐渐变为紧密粗糙，核仁由清晰到消失胞质透明天蓝，颗粒少21plasmacyte)22由圆形变为卵圆形核保
6、持圆形胞质由浅灰蓝变为深蓝(plasmacytes)2324胞体变为不规则形核变为一侧凹陷，后成肾形，不规则形，有扭曲折叠染色质结构由细致疏松逐渐变为紧密粗糙，核仁由清晰到消失单核系呈浅灰蓝,颗粒由无到有monocytes25egakaryocyte)26egakaryocytes)2728293031323334骨髓中各系细胞的细胞名称范围平均值标准差原始粒细胞0-1.80.6 40.3 3早幼粒细胞0.4-3.91.5 70.6 0中幼2.2-1 2.26.4 92.0 4晚幼3.5-1 3.27.9 01.9 7杆状核1 6.4-3 2.12 3.7 23.0 5中性粒细胞分叶核4.2-
7、2 1.29.4 42.9 2中幼0-1.40.3 80.2 3晚幼0-1.80.4 90.3 2杆状核0.2-3.91.2 50.6 1嗜酸性粒细胞分叶核0-4.20.8 60.6 1中幼0-0.20.0 20.0 5晚幼0-0.30.0 60.0 7杆状核0-0.40.1 00.0 9粒细胞系统嗜碱性粒细胞分叶核0-0.20.0 30.0 5原红细胞0-1.90.5 70.3 0早幼红细胞0.2-2.60.9 20.4 1中幼红细胞2.6-1 0.77.4 11.9 1红细胞系统晚幼红细胞5.2-1 7.51 0.7 52.3 6原淋巴细胞0-0.40.0 50.0 9幼淋巴细胞0-2.1
8、0.4 70.8 4淋巴细胞系统淋巴细胞1 0.7-1 3.12 2.7 87.0 4原单核细胞0-0.30.0 10.0 4幼单核细胞0-0.60.1 00.1 9单核细胞系统单核细胞1.0-6.23.00.8 8原浆细胞0-0.10.0 0 40.0 2幼浆细胞0-0.70.1 0 40.1 6浆细胞系统浆细胞0-2.10.7 10.4 2巨核细胞0-0.30.0 30.0 6网状细胞0-1.00.1 60.2 1内皮细胞0-0.40.0 50.0 9吞噬细胞0-0.40.0 50.0 9组织嗜碱细胞0-0.50.0 30.0 9组织嗜酸细胞0-0.20.0 0 40.0 3脂肪细胞0-0
9、.10.0 0 30.0 2其他细胞分类不明显细胞0-0.10.0 1 50.0 4红系核分裂细胞0-1 7.04.9 03.1 0粒系核分裂细胞0-7.01.3 01.9 0粒细胞:幼红细胞1.2 8-5.9 52.7 6:10.8 735Contents and Methods36excessive overactivity)100倍倍37100倍倍38100倍倍39有核细胞：成熟红细胞 1 ：50100倍倍40100倍倍41100 倍倍4243 (1)excessive overactivity:acute lymphocytic leukemia etc.44Compensatory
10、hyperplasia sites.agranulocytosis；Myelofibrosis and old people45granulocytemyeloblastpromyelocytechronic myelocytic leukemia46leukemoid reaction47（3）红细胞系统）红细胞系统4849Lymphocytic leukemiainfectious lymphocytosisinfectious mononucleosis5051malignant histiocytosis52tuberculosisbrucellosismalariamalariaIn
11、fective endocarditissystemic lupus erythematosus，SLErheumatoid arthritis，RAcirrhosis of liver53Plasmacytic leukemiamacroglobulinemiaheavy chain diseasereactive plasmacytosishypersensitivity54Granulocytic leukemiapolycythemia veraMyelofibrosishypersplenia55intoxicationRadiation disease56一些常见病的骨髓及血象特点一些常见病的骨髓及血象特点57leukemia)5859M 400倍 B 400倍 60 M1000倍61M 1000倍M 400倍62 M400倍63 M1000倍64 M1000倍65M 1000倍原粒细胞原粒细胞6667686970 M 200倍骨髓病理切片骨髓病理切片骨髓涂片骨髓涂片组织嗜碱细胞组织嗜碱细胞7172晚巨红细胞晚巨红细胞7374diopathic thrombocytopenic purpura)幼稚巨核细胞幼稚巨核细胞颗粒巨核细胞颗粒巨核细胞7576
