骨髓细胞形态学ppt课件.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 1 5增生极度活跃 1 10增生明显活跃 1 20增生活跃 1 20 50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 20 mindiameter roundorovalN roundoroval centraloreccentric finechromatininreddish purple 2 5obviousnucleoliC smallamount transparentskyblueordeepblue nogranuleorafew type S sizeandshapeN nucleusC cytoplasm Promyelocyte早幼粒细胞 S 12 25 m largerthanmyeloblast roundorovalN roundorovalorslightlyindented centraloreccentric slightlycoarserchromatinpattern nucleoli oftenvisibleC moderateorabundantinamount palebluetodeepblueincolor containsafewormanyazurophilicgranuleswhicharevariableinsizeandshape oftenovernucleus NeutrophilicMyelocyte中性中幼粒细胞 S 10 20 m round reductioninN CN ovalorslightlydistorted usuallyeccentric chromatinpatternbecomescoarser purpleincolor withoutnucleoliC abundant reddishorlightblue pinkspecificsecondarygranulesmaybeseenaspinkishareasnearthenucleusfirst barelyvisible NeutrophilicMetamyelocyte中性晚幼粒细胞 S 10to16 m roundN kidneyorhorseshoeshaped eccentric withcoarserchromatinpattern vice chromatin 副染色质 appearsC abundant reddish fullofpinkneutrophilicgranules NeutrophilicStabgranulocyte中性杆状核粒细胞 S 10to15 m roundN bandshaped U shaped S shaped coarsechromatin distinctvice chromatinC sameasthemetamyelocyte NeutrophilicSegmentedGranulocyte中性分叶核粒细胞 S 10to14 m 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 25 m roundwithpseudopod 伪足 N round central granulouschromatinstainedreddish purple 1 3bluishnucleoliC moderateinamount deepblueincolorandopaque showingtumorlikeprotrusionandadistinctperinuclearpalezone nogranules Earlynormoblast早幼红细胞 S 10 18 m roundorovalN round centralchromatinpatternslightlycondensednucleoliarepresent butnotalwaysvisibleC moderateinamount intenselyblueandopaque perinuclearpalezoneisvisible Polychromaticnormoblast中幼红细胞 S 8 15 m roundN smaller round central chromatinpatternmorecondensedindeeppurplewithdistinctvice chromatin nucleoliabsentC abundantinquantity polychromatic grey bluetopink grey Orthochromaticnormoblast晚幼红细胞 S 7 10 m roundN round centraloreccentric pyknoticchromatinpatterninblackpurple vice chromatinmayvisibleorinvisible sometimesextrusionC abundantinquantity pinkerthanpreviousstage Erythrocyte红细胞 6 8 mindiameter 7 2 monaverage 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 30 m roundorirregularN large roundorirregular coarsereticularandcondensedchromatininpurple 2 3vaguenucleoliC smalltomoderatecytoplasmindeepblue mayhavepseudopod nogranules Promegakaryocyte幼稚巨核细胞 S 30 50 m irregularN irregularinshape mayshowslightlobulation multi nuclei coarserchromatin nucleoliindistinctC moreamountcytoplasmindeepblue reddish purplegranulesvisible pseudopodvisible Granularmegakaryocyte颗粒型巨核细胞 S giant 40 70 m integritymembraneN giant multiplenucleiormulti lobulationvisible coarserpatchychromatinpatternC veryplentifulcytoplasmfullofpurplegranules Thrombopoieticmegakaryocyte产血小板型巨核细胞 S 40 70 m 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 18 mN Roundtooval maybeslightlyindentedC Scanttomoderate skyblue vacuolesmaybepresent 单核系Monocyte 骨髓单核细胞正常值 0 2 9 S 12 20 mN Variable mayberound horseshoeshaped orkidneyshaped oftenhasfoldsproducing brainlike convolutionsC Blue gray mayhave