Bone Marrow

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Bone Marrow
2012-09-03 21:29:37
Lab Tech ll

Lab Tech ll
Show Answers:

  1. List 5 different specific indications for a bone marrow biopsy.
    • a diagnostic aid
    • an unexplained increase in blood cells
    • an unexplained decrease in blood cells
    • when we see abnormal cells in peripheral blood
    • to look for mast cells if MCT
  2. Do we use anesthesia to collect bone marrow?  Why or why not?
    • yes, local or general
    • for aseptic technique
  3. What places on a small animal can we collect bone marrow?
    • iliac crest
    • trochanteric fossa
    • proximal humerus
  4. What places on a large animal can we collect bone marrow?
    posterior rib or iliac crest
  5. How do we collect the sample?
    • place needle in lumen of the bone
    • we want bone spicules
    • use an anticoagulant
    • either make 2 - 5 slides and stain one or place part in 10% formalin to send off for biopsy
  6. Describe the cytologic findings of a normal marrow sample.
    • cells appear normal:  size, N:C ratio, staining
    • M:E ratio is within normal limits
    • mature cells > immature cells
  7. List in order the megakaryocyte series.
    • megakaryoblast
    • promegakaryocyte
    • megakaryocyte
  8. List in order the erythroid series.
    • rubriblast
    • prorubricyte
    • rubricyte
    • metarubricyte
    • reticulocyte
    • mature erythrocyte
  9. List in order the granulocytic series.
    • myeloblast
    • progranulocyte
    • myelocyte
    • metamyelocyte
    • band
    • mature granulocyte
  10. How do the cells of the erythrocyte series differ in appearance from those of the granulocyte series?
    • in the erythrocyte series, the cells and nucleus are round and have basophilic cytoplasm
    • in the granulocyte series, the nucleus goes from round to kidney shaped and the cytoplasm is pale blue
  11. Define plasma cell.
    comes from lymphocytes and produce antibodies
  12. Define osteoclast.
    breaks down bone.
  13. Define promonocyte.
    Second stage in monocytopoiesis
  14. Define osteoblast.
    makes bone
  15. Define Mott cell.
    plasma cell full of russell bodies
  16. What is the M:E ratio and what does it tell the VMD?  List 2 causes of a high ratio.  List 2 causes of a low ratio.
    • myeloid vs. erythroid
    • high ratio:  greater than 3...myeloid hyperplasia or erythroid hypoplasia
    • low ratio:  below 0.5...myeloid hypoplasia or erythroid hyperplasia
  17. Name 3 myeloproliferative disorders that affect the bone marrow.
    • multiple myelonma
    • lymphoma/small cell lymphoma
    • mast cell tumor
    • leukemia
  18. Where are blood cells produced?
    in the medullary cavity of long bones
  19. What are the 5 common stem cells produced in the bone marrow?
    • erythropoiesis
    • granulopoiesis
    • monocytopoiesis
    • lymphopoiesis
    • thrombocytopoiesis
  20. What does a bone marrow needle look like?
    • large hub
    • stainless steel
    • 11 - 16 gauge
    • short bevel
    • stylet
  21. What supplies do we need to perform a bone marrow aspirate?
    • #10 blade (to nick skin)
    • 2 - 3 (12 ml syringes)
    • bone marrow needle with stylet
    • local or general anesthesia
    • about 20 clean slides
    • EDTA
  22. Describe how to aspirate a bone marrow sample.
    • attach syringe to needle
    • apply negative pressure - quickly
    • release as soon as you see red stuff
    • repeat until you see material in the hub and then stop
  23. How do we evaluate a bone marrow slide?
    • scan on low then on high
    • evaluate cells under oil
    • identify/classify 500 cells
  24. What are the three different categories we should sort our 500 cells into?
    • red cell
    • white cell
    • other
  25. Other than counting cells, what is the other thing we do when we are evaluating a bone marrow slide?
    calculate M:E ratio
  26. What kind of stain do we use for bone marrow slides?
    diff quik
  27. Describe what the cells look like in the red cell series.
    • round cells
    • round nuclei
    • narrow rim of bright blue cytoplasm
    • get smaller as they mature
  28. What do the cells in the red cell series look similar to?
  29. As the RBC matures, how does the cytoplasm change?
    the cytoplasms size, shape, and color changes
  30. As the RBC matures, how does the nucleus change?
    shape, color, and size
  31. What is pyknosis?
    • dead nucleus 
    • whats in a nucleated red blood cell
  32. As the RBC matures, how does the chromatin change?
    chromatin goes from vesicular to clumpy.
  33. What does a vesicular chromatin look like?
  34. Describe the look of a rubriblast.
    • large cell
    • narrow rim of bright blue cytoplasm
    • round nucleus
    • 1 - 2 nucleoli in nucleus
    • lacey chromatin
  35. What is the nucleoli involved in?
    protein synthesis
  36. If a cell has characteristics of 2 different stages of the cell, what stage do we classify it as?
    the more mature stage
  37. Describe a prorubricyte.
    same as a rubriblast EXCEPT no nucleolus present and has a perinuclear clear zone
  38. Describe a rubricyte.
    • smaller cell
    • round nucleus
    • clumpy, coarse chromatin
  39. Describe a metarubricyte.
    • even smaller than a rubricyte
    • cytoplasm blue to pinkish
    • nucleus small and dark and eccentric
  40. What stage of the red cell series does mitosis stop?
  41. What does an eccentric nucleus mean?
    off to the side of the cell
  42. Describe what a myeloblast looks like.
    • large cell
    • lots of pale blue cytoplasm
    • round - oval nucleus
    • 1 - 2 nucleoli
  43. Describe a progranulocyte.
    • larger than a myeloblast, but can be smaller at times
    • no nucleoli
    • perinuclear clear zone
    • small pinkish cytoplasmic granules
  44. What are small pinkish cytoplasmic granules called?
    azurophilic granules
  45. Describe a myelocyte.
    • smaller cell
    • larger distince cytoplasmic granules
    • nucleus is round to oval
  46. Describe a metamyelocyte
    • indented, kidney shaped nucleus
    • may see granules in cytoplasm
    • mature into bands
  47. Describe a band.
    nucleus has parallel sides
  48. What is the series of cells in monocytopoiesis?
    • monoblast
    • promonocyte
    • monocyte
  49. Do we cell a lot of monocytes in bone marrow?
  50. What is the series of cells in lymphopoiesis?
    • lymphoblast
    • prolymphocyte
    • lymphocyte
  51. What does a lymphoblast look like?
    large lymph with nucleolus
  52. What does a prolymphocyte look like?
    smaller than lymphoblast with no nucleolus
  53. If we see large numbers of lymphocytes in bone marrow, what could it indicate?
    lymphoma or lympho-prolierative leukemia
  54. What can we confuse lymphocytes with?
  55. What are "free nucleus"?
    skipocytes in bone marrow, can not count these as cell
  56. What breaks of megakaryocytes?
  57. Describe a megakaryoblast.
    • large cell
    • multinuclear mass
    • small amount of cytoplasm
  58. Describe a promegakaryocyte.
    • large cell
    • multinuclear mass
    • more cytoplasm
  59. Describe a megakaryocyte.
    • largest cell of the series
    • multinuclear mass
    • large amount of cytoplasm
  60. What is the difference in appearance between a osteoclast and a megakaryocyte?
    • megakaryocyte is multinuclear but they are clumped together
    • osteoclast has different distincy nuclei
  61. Which is seen more frequently in bone marrow, osteoclast or osteoblast?
  62. What does an osteoblast look like?
    • oval, eccentric nucleus
    • nucleoli
    • large amount of basophilic cytoplasm
  63. What does a plasma cell look like?
    • round cell
    • round eccentric nucleus with clumpy chromatin
    • perinuclear pale zone
    • large amounts of basophilic cytoplasm full of vacuoles and russell bodies
  64. What turns into plasma cells?
  65. What are russell bodies and where do we see them?
    • antibodies
    • in the cytoplasm of plasma cells
  66. What should always be done the same day as a bone marrow aspirate?
  67. How do we do a M:E ratio?
    • add up # of white cells
    • add up # of red cells
    • divide and make a ratio

    example:  275 white cells and 225 red cells...ratio 275/225 = 1.2:1
  68. What is the normal limit for a M:E ratio?
    1 - 3:1
  69. What is considered an elevated M:E ratio?
    ratio greater than 3
  70. What is an elevated M:E ratio due to?
    increase in WBCs or decrease in RBCs
  71. What are the two situations that can cause an elevated M:E ratio?
    • myeloid hyperlasia
    • erythroid hypoplasia
  72. What do we expect to see on the CBC with a myeloid hyperplasia?
  73. What do we expect to see on the CBC with a erythroid hypoplasia?
  74. What is considered a decreased M:E ratio?
    ratio below 0.5 (example:  1:2)
  75. What is a decreased M:E ratio due to?
    decrease in WBCs or increase in RBCs
  76. What are the two situations that can cause a decrease in M:E ratio?
    • myeloid hypoplasia
    • erythroid hyperplasia
  77. What do we expect to see on a CBC with myeloid hypoplasia?
  78. What do we expect to see on a CBC with a erythroid hyperplasia?
    responsive anemia
  79. What other findings might we see on a bone marrow aspirate?
    • no RBCs or WBCs
    • increase in abnormal cells
    • undifferentiated large cells
  80. What is it called when there are no RBCs or WBCs in the bone marrow?
  81. What is aplasia?
    lack of cell production
  82. What can aplasia be due to?
    • immunosuppressive drugs (radiation, chemo)
    • viruses (parvo, ehrlichia)
  83. What will need to be done if there we find aplasia in the bone marrow?
    bone marrow transplant
  84. What are cells can become abnormal and increased in the bone marrow and what does it usually indicate?
    • lymphocytes
    • lymphoma
  85. If we see undifferentiated large cells in the bone marrow (we can not tell them apart), what does that usually indicate?
    some type of neoplasia
  86. What are myeloproliferative disorders?
    • cell production out of control (preneoplasia)
    • immature cells > mature cells
  87. What is multiple myeloma?
    neoplasia of plasma cells
  88. What will show up on radiographs on an animal with multiple myeloma?
    dark holes in the bone
  89. What is the main clinical sign of multiple myeloma?
  90. What will we see in the bone marrow in an animal with multiple myeloma
    plasma cells in the bone marrow
  91. Describe a mast cell.
    purple cytoplasmic granules that cover up the nucleus

  92. Which ones are bands
    the cells with the "u" shaped nucleus

  93. What is wrong?
    erythroid hyperplasia

  94. What is wrong?
    granulocyte hyperplasia

  95. What is this a group of?
    osteoblasts (very eccentric nucleus)

  96. Identify the rubriblast.
    the large round cell on the left

  97. What are these kinds of cells?
    leukemic cells

  98. What are these cells?  What is the cell in the middle?
    • leukemic cells
    • rubricyte

  99. What is this indicate?

  100. What is this?
    mast cell tumor

  101. What kind of cell is this?
    megakaryoblast:  multinuclear, small amount of cytoplasm

  102. What kind of cell is this?
    megakaryocyte:  large amounts of cytoplasm, multinuclear

  103. Which one is a metamyelocyte?
    • the one on the right
    • indented-kidney shaped nucleus

  104. What kind of cell is this?
    Mott cell:  full of vacuoles, russell bodies

  105. What is this?
    multiple myeloma

  106. Identify the myeloblast.
    • large cell on the left
    • lots of pale blue cytoplasm
    • round - oval nucleus
    • 1 - 2 nucleoli

  107. What are these?
    myelocyte:  large distincet cytoplasmic granules, nucleus is round to oval

  108. Identify the myeloids and the erythroids.

  109. What is this?

  110. What is this?

  111. What is this?

  112. What is the cell in the middle?
    plasma cell:  round cell, round nucleus, eccentric nucleus

  113. What is this?
    progranulocyte:  no nucleoli, perinuclear clear zone, small pinkish cytoplasmic granules

  114. What is this?
    promegakaryocyte:  multinuclear mass, more cytoplasm

  115. What is this?
    prorubricyte:  no nucleolus, perinuclear clear zone, lacey chromatin

  116. Which ones are RBCs and which ones are WBCs

  117. What is at the pointer?
    rubriblast:  narrow rim of bright blue cytoplasm, round nucleus, 1 - 2 nucleoli

  118. What is wrong?
    small cell lymphoma

  119. What is happening in this picture?
    thrombocyte release

  120. What are these?