骨髓细胞形态学.PPT

1、1,骨髓细胞形态学检查,2,骨髓的造血分化,Stem cells,外周血或淋巴系统,3,骨髓穿刺,涂片细胞学,活检组织学,4,粒系：红系=1-5.2:1,5,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；1:20 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

2、：（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,6,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 MPD G-CSF,正常骨髓,AA 化疗骨髓抑制 低增生MDS,7,8,血细胞发育过程中形态演变的一般规律,9,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,10,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) Neutro

3、phil (分叶核粒细胞,11,How to identify a cell,Cell: size, shape, N:C,Nucleus(胞核): shape，location, chromatin pattern, nucleoli,Cytoplasm(胞浆): color, amount, granule, vacuole, inclusion body,12,Myeloblast 原粒细胞,S: 10-20 m in diameter, round or oval N: round or oval, central or eccentric, fine chromatin in red

4、dish-purple, 2-5 obvious nucleoli C: small amount, transparent sky blue or deep blue, no granule or a few (type,S: size and shape N: nucleus C: cytoplasm,13,Promyelocyte 早幼粒细胞,S: 12-25 m, larger than myeloblast, round or oval N: round or oval or slightly indented , central or eccentric, slightly coa

5、rser chromatin pattern, nucleoli: often visible C: moderate or abundant in amount, pale blue to deep blue in color, contains a few or many azurophilic granules which are variable in size and shape, often over nucleus,14,Neutrophilic Myelocyte 中性中幼粒细胞,S: 10-20 m, round , reduction in N:C N: oval or s

6、lightly distorted, usually eccentric, chromatin pattern becomes coarser, purple in color, without nucleoli C: abundant, reddish or light blue, pink specific secondary granules may be seen as pinkish areas near the nucleus first (barely visible,15,Neutrophilic Metamyelocyte 中性晚幼粒细胞,S: 10 to 16 m, rou

7、nd N: kidney or horseshoe shaped , eccentric, with coarser chromatin pattern, vice-chromatin（副染色质）appears C: abundant, reddish, full of pink neutrophilic granules,16,Neutrophilic Stab granulocyte 中性杆状核粒细胞,S: 10 to 15 m, round N: band shaped, U-shaped, S-shaped, coarse chromatin, distinct vice-chroma

8、tin C: same as the metamyelocyte,17,Neutrophilic Segmented Granulocyte 中性分叶核粒细胞,S: 10 to 14 m, round N: usually 2 to 5 lobes, connected by filaments strand of heterochromatin, coarse clumped chromatin pattern. C: abundant in reddish with a full complement of rose-violet specific granules,18,Eosinoph

9、ils嗜酸性粒细胞,1,2,4,3,19,Basophils 嗜碱性粒细胞,20,红系各阶段组成,Erythrocyte series红系 pronormoblast （原始红细胞） early(basophilic) normoblast （早幼红细胞） polychromatic normoblast （中幼红细胞） orthochromatic normoblast （晚幼红细胞） reticulocyte （网织红细胞） erythrocyte (RBC) （红细胞,21,Pronormoblast 原始红细胞,S: 15-25 m，round with pseudopod（伪足） N

10、: round, central, granulous chromatin stained reddish-purple, 1-3 bluish nucleoli C: moderate in amount , deep blue in color and opaque, showing tumor like protrusion and a distinct perinuclear pale zone, no granules,22,Early normoblast 早幼红细胞,S: 10-18 m, round or oval N: round, central chromatin pat

11、tern slightly condensed nucleoli are present, but not always visible C: moderate in amount, intensely blue and opaque, perinuclear pale zone is visible,23,Polychromatic normoblast 中幼红细胞,S: 8-15 m, round N: smaller, round, central, chromatin pattern more condensed in deep purple with distinct vice-ch

12、romatin , nucleoli absent C: abundant in quantity, polychromatic (grey-blue to pink-grey,24,Orthochromatic normoblast 晚幼红细胞,S: 7-10 m, round N: round, central or eccentric, pyknotic chromatin pattern in black purple, vice-chromatin may visible or invisible, sometimes extrusion C: abundant in quantit

13、y, pinker than previous stage,25,Erythrocyte 红细胞,6-8 m in diameter, 7.2 m on average, a small area of central pallor, anuclear, pink, biconcave disk,26,巨核系,巨大细胞 低倍镜观察 7-35枚/涂片 产生血小板,Normal megakaryocyte,正常人16N巨核细胞占50%-55%，8N及32N占10-30%，2N，4N，64N，128N极少,27,stages of megakaryocytic maturation: megakar

14、yoblast （原始巨核细胞） promegakaryocyte （幼稚巨核细胞） granular megakaryocyte （颗粒型巨核细胞） thrombocytopoietic megakaryocyte(产血小板型巨核细胞) naked megakaryocyte （裸核型巨核细胞） platelet （血小板,Megakaryocyte series,Megakaryocytopoiesis development occurs by endomitosis,28,Megakaryoblast 原始巨核细胞,S: 15-30 m, round or irregular N: l

15、arge, round or irregular. coarse reticular and condensed chromatin in purple, 2-3 vague nucleoli C: small to moderate cytoplasm in deep blue, may have pseudopod, no granules,29,Promegakaryocyte 幼稚巨核细胞,S: 30-50 m, irregular N: irregular in shape, may show slight lobulation, multi-nuclei, coarser chro

16、matin, nucleoli indistinct C: more amount cytoplasm in deep blue, reddish-purple granules visible, pseudopod visible,30,Granular megakaryocyte 颗粒型巨核细胞,S: giant, 40-70 m, integrity membrane N: giant , multiple nuclei or multi-lobulation visible, coarser patchy chromatin pattern C: very plentiful cyto

17、plasm full of purple granules,31,Thrombopoietic megakaryocyte 产血小板型巨核细胞,S: 40-70 m, irregular, blurred membrane N: giant, extremely hyperploid nuclei often overlie with clumped chromatin C: very plentiful cytoplasm in reddish, granules cluster and bud off to become platelet,32,Naked megakaryocyte 裸核

18、型巨核细胞,A mature megakaryocytic nucleus without cytoplasm,33,骨髓淋巴细胞正常值8.4-32.4,淋巴系 Lymphocyte,S: 7-18 m N: Round to oval; may be slightly indented C: Scant to moderate; sky blue; vacuoles may be present,34,单核系 Monocyte,骨髓单核细胞正常值：0-2.9,S: 12-20 m N: Variable; may be round, horse shoe shaped, or kidney shaped; often has folds producing “brainlike” convolutions C: Blue-gray; may have p