骨髓细胞形态学.ppt

骨髓细胞形态学检查,骨髓的造血分化,Stemcells,外周血或淋巴系统,骨髓穿刺,涂片细胞学,活检组织学,粒系：红系=1-5.2:1,骨髓涂片,增生判断：有核细胞：红细胞1:15增生极度活跃；1:10增生明显活跃；1:20增生活跃；1:2050增生尚可；1：50增生低下；1:200增生极度低下。取材稀释判断：取材稀释为取材时混入外周血，导致骨髓成份减少或缺如，无法代表骨髓。1、外观无或少骨髓小粒2、骨髓分类成熟粒细胞为主或淋巴细胞为主，骨髓有核细胞少（幼粒幼红及巨核细胞少）3、骨髓非造血细胞少：包括浆细胞，成纤维细胞，吞噬细胞，组织嗜碱性粒细胞等骨髓干抽：（穿刺技术没有问题，分类结果如稀释或多次骨穿失败)1、骨髓纤维化（骨质硬），是其特点。2、骨髓细胞太多：白血病,骨髓增生程度,增生极度活跃,增生活跃,增生极度低下,白血病MPDG-CSF,正常骨髓,AA化疗骨髓抑制低增生MDS,血细胞发育过程中形态演变的一般规律,粒系红系巨核淋巴系单核系浆细胞系,骨髓中各系比例和形态,粒系各阶段组成,Myeloid（粒系）Myeloblast(原始粒细胞)Promyelocyte(早幼粒细胞)Mylocyte(中幼粒细胞)Metamylocyte(晚幼粒细胞)Band(杆状核细胞)Neutrophil(分叶核粒细胞),Howtoidentifyacell?,Cell:size,shape,N:C,Nucleus(胞核):shape，location,chromatinpattern,nucleoli,Cytoplasm(胞浆):color,amount,granule,vacuole,inclusionbody,Myeloblast原粒细胞,S:10-20mindiameter,roundorovalN:roundoroval,centraloreccentric,finechromatininreddish-purple,2-5obviousnucleoliC:smallamount,transparentskyblueordeepblue,nogranuleorafew(type),S:sizeandshapeN:nucleusC:cytoplasm,Promyelocyte早幼粒细胞,S:12-25m,largerthanmyeloblast,roundorovalN:roundorovalorslightlyindented,centraloreccentric,slightlycoarserchromatinpattern,nucleoli:oftenvisibleC:moderateorabundantinamount,palebluetodeepblueincolor,containsafewormanyazurophilicgranuleswhicharevariableinsizeandshape,oftenovernucleus,NeutrophilicMyelocyte中性中幼粒细胞,S:10-20m,round,reductioninN:CN:ovalorslightlydistorted,usuallyeccentric,chromatinpatternbecomescoarser,purpleincolor,withoutnucleoliC:abundant,reddishorlightblue,pinkspecificsecondarygranulesmaybeseenaspinkishareasnearthenucleusfirst(barelyvisible),NeutrophilicMetamyelocyte中性晚幼粒细胞,S:10to16m,roundN:kidneyorhorseshoeshaped,eccentric,withcoarserchromatinpattern,vice-chromatin（副染色质）appearsC:abundant,reddish,fullofpinkneutrophilicgranules,NeutrophilicStabgranulocyte中性杆状核粒细胞,S:10to15m,roundN:bandshaped,U-shaped,S-shaped,coarsechromatin,distinctvice-chromatinC:sameasthemetamyelocyte,NeutrophilicSegmentedGranulocyte中性分叶核粒细胞,S:10to14m,roundN:usually2to5lobes,connectedbyfilamentsstrandofheterochromatin,coarseclumpedchromatinpattern.C:abundantinreddishwithafullcomplementofrose-violetspecificgranules,Eosinophils嗜酸性粒细胞,1,2,4,3,Basophils嗜碱性粒细胞,红系各阶段组成,Erythrocyteseries红系pronormoblast（原始红细胞）early(basophilic)normoblast（早幼红细胞）polychromaticnormoblast（中幼红细胞）orthochromaticnormoblast（晚幼红细胞）reticulocyte（网织红细胞）erythrocyte(RBC)（红细胞）,Pronormoblast原始红细胞,S:15-25m，roundwithpseudopod（伪足）N:round,central,granulouschromatinstainedreddish-purple,1-3bluishnucleoliC:moderateinamount,deepblueincolorandopaque,showingtumorlikeprotrusionandadistinctperinuclearpalezone,nogranules,Earlynormoblast早幼红细胞,S:10-18m,roundorovalN:round,centralchromatinpatternslightlycondensednucleoliarepresent,butnotalwaysvisibleC:moderateinamount,intenselyblueandopaque,perinuclearpalezoneisvisible,Polychromaticnormoblast中幼红细胞,S:8-15m,roundN:smaller,round,central,chromatinpatternmorecondensedindeeppurplewithdistinctvice-chromatin,nucleoliabsentC:abundantinquantity,polychromatic(grey-bluetopink-grey),Orthochromaticnormoblast晚幼红细胞,S:7-10m,roundN:round,centraloreccentric,pyknoticchromatinpatterninblackpurple,vice-chromatinmayvisibleorinvisible,sometimesextrusionC:abundantinquantity,pinkerthanpreviousstage,Erythrocyte红细胞,6-8mindiameter,7.2monaverage,asmallareaofcentralpallor,anuclear,pink,biconcavedisk,巨核系,巨大细胞低倍镜观察7-35枚/涂片产生血小板,Normalmegakaryocyte,正常人16N巨核细胞占50%-55%，8N及32N占10-30%，2N，4N，64N，128N极少。,stagesofmegakaryocyticmaturation:megakaryoblast（原始巨核细胞）promegakaryocyte（幼稚巨核细胞）granularmegakaryocyte（颗粒型巨核细胞）thrombocytopoieticmegakaryocyte(产血小板型巨核细胞)nakedmegakaryocyte（裸核型巨核细胞）platelet（血小板）,Megakaryocyteseries,Megakaryocytopoiesisdevelopmentoccursbyendomitosis,Megakaryoblast原始巨核细胞,S:15-30m,roundorirregularN:large,roundorirregular.coarsereticularandcondensedchromatininpurple,2-3vaguenucleoliC:smalltomoderatecytoplasmindeepblue,mayhavepseudopod,nogranules,Promegakaryocyte幼稚巨核细胞,S:30-50m,irregularN:irregularinshape,mayshowslightlobulation,multi-nuclei,coarserchromatin,nucleoliindistinctC:moreamountcytoplasmindeepblue,reddish-purplegranulesvisible,pseudopodvisible,Granularmegakaryocyte颗粒型巨核细胞,S:giant,40-70m,integritymembraneN:giant,multiplenucleiormulti-lobulationvisible,coarserpatchychromatinpatternC:veryplentifulcytoplasmfullofpurplegranules,Thrombopoieticmegakaryocyte产血小板型巨核细胞,S:40-70m,irregular,blurredmembraneN:giant,extremelyhyperploidnucleioftenoverliewithclumpedchromatinC:veryplentifulcytoplasminreddish,granulesclusterandbudofftobecomeplatelet,Nakedmegakaryocyte裸核型巨核细胞,Amaturemegakaryocyticnucleuswithoutcytoplasm,骨髓淋巴细胞正常值8.4-32.4%,淋巴系Lymphocyte,S:7-18mN:Roundtooval;maybeslightlyindentedC:Scanttomoderate;skyblue;vacuolesmaybepresent,单核系Monocyte,骨髓单核细胞正常值：0-2.9%,S:12-20mN:Variable;mayberound,horseshoeshaped,orkidneyshaped;oftenhasfoldsproducing“brainlike”convolutionsC:Blue-gray;mayhaveps