Showing posts with label Bone Marrow. Show all posts
Showing posts with label Bone Marrow. Show all posts
Wednesday, January 13, 2010
Friday, April 17, 2009
Bone Marrow Pathology
http://www.pathology.vcu.edu/education/programs/resident/NewSite/Marrow%204.pdf
This is a great interactive bone marrow pathology site!
For more information on Shwachman-Diamond Syndrome, please see Shwachman-Diamond America
This is a great interactive bone marrow pathology site!
For more information on Shwachman-Diamond Syndrome, please see Shwachman-Diamond America
Wednesday, March 5, 2008
Dysplasia
from Answers.com
Hypersegmented (osteoclastic appearing) megakaryocytes Ballooning of the platelets (seen with interference contrast microscopy)
Dysplasia can affect all three lineages seen in the bone marrow. The best way to diagnose dysplasia is by morphology and special stains (PAS) used on the bone marrow aspirate and peripheral blood smear. Dysplasia in the myeloid series is defined by:
- Granulocytic series
- Hypersegmented neutrophils (also seen in Vit B12/Folate deficiency)
- Hyposegmented neutrophils (Pseudo-Pelger Huet)
- Hypogranular neutrophils or pseudo Chediak Higashi large granules
- Dimorphic granules (basophilic and eosinophilic granules) within eosinophils
- Erythroid series
- Binucleated erythroid percursors and karyorrhexis
- Erythroid nuclear budding
- Erythroid nuclear strings or internuclear bridging (also seen in congenital dyserythropoietic anemias)
- PAS (globular in vacuoles or diffuse cytoplasmic staining) within erythroid precursors in the bone marrow aspirate (has no bearing on paraffin fixed bone marrow biopsy). Note: One can see PAS vacuolar positivity in L1 and L2 blasts (AFB classification; the L1 and L2 nomenclature is not used in the WHO classification)
- Ringed sideroblasts seen on Prussian blue iron stain (10 or more iron granules encircling 1/3 or more of the nucleus and >15% ringed sideroblasts when counted amongst red cell precursors)
- Megakaryocytic series (can be the most subjective)
Sunday, March 2, 2008
Cytogenetics, blood, bone marrow and tissue
Blood & Tissue Cytogenetics
Blood Cytogenetics: Chromosomal analysis on peripheral blood is a good way to look at the constitutional chromosomal make-up or karyotype of an individual. Peripheral blood is drawn and cultured in tissue culture media supplemented with a mitogen, PHA (phytohemagglutinin), that causes the lymphocytes to grow in culture. After 48 to 96 hours in culture, metaphase chromosomes are “harvested” and slides made for chromosome analysis. Peripheral blood can be used as a substitute for a bone marrow aspirate when one cannot be obtained and circulating blasts are present.
Bone Marrow Cytogenetics: Bone marrow cytogenetic analysis is performed on patients with leukemia, lymphoma or other hematological disorders. These patients often have acquired clonal chromosomal abnormalities that can be diagnostic and/or prognostic.
Breakage Studies: Ataxia telangiectasia (AT) is a rare, autosomal recessive chromosomal breakage syndrome characterized by progressive cerebellar ataxia, telangiectasias, immune deficiency and a predisposition to malignancy. Fanconi anemia (FA) is a rare, autosomal recessive condition characterized by growth retardation, thumb abnormalities/radial aplasia, pigmentary anomalies and hematological disorders, including eventually MDS and AML. Both disorders are associated with a DNA repair defect that leads to an increased rate of spontaneous chromosomal breakage when blood is exposed to mitomycin C and/or diepoxybutane.
Solid Tumor Cytogenetics: Cytogenetic analysis can be an important adjunct to solid tumor diagnosis and management. This is particularly true in the case of the small round blue cell tumors of childhood (Ewing’s sarcoma/PNET; rhadomyosarcomas).
Tissue Cytogenetics: Solid tissue specimens can be cultured as a source for mitotic cells for chromosomal analysis. Products of conception (POC) specimens from the first trimester spontaneous abortions are often studied. Around half of these are chromosomally abnormal, typically aneuploidies. Tissues from intrauterine fetal demises or stillborns can also be studied and may help confirm abnormal prenatal results. Tissues should be of fetal, not maternal, origin (e.g. fetal tissue, membranes, villi). Internal organs/diaphragm obtained at autopsy can be used. Skin punch biopsies may also be obtained to rule out chromosomal mosaicism or to culture for biochemical and/or molecular analysis.
From this link
Blood Cytogenetics: Chromosomal analysis on peripheral blood is a good way to look at the constitutional chromosomal make-up or karyotype of an individual. Peripheral blood is drawn and cultured in tissue culture media supplemented with a mitogen, PHA (phytohemagglutinin), that causes the lymphocytes to grow in culture. After 48 to 96 hours in culture, metaphase chromosomes are “harvested” and slides made for chromosome analysis. Peripheral blood can be used as a substitute for a bone marrow aspirate when one cannot be obtained and circulating blasts are present.
Bone Marrow Cytogenetics: Bone marrow cytogenetic analysis is performed on patients with leukemia, lymphoma or other hematological disorders. These patients often have acquired clonal chromosomal abnormalities that can be diagnostic and/or prognostic.
Breakage Studies: Ataxia telangiectasia (AT) is a rare, autosomal recessive chromosomal breakage syndrome characterized by progressive cerebellar ataxia, telangiectasias, immune deficiency and a predisposition to malignancy. Fanconi anemia (FA) is a rare, autosomal recessive condition characterized by growth retardation, thumb abnormalities/radial aplasia, pigmentary anomalies and hematological disorders, including eventually MDS and AML. Both disorders are associated with a DNA repair defect that leads to an increased rate of spontaneous chromosomal breakage when blood is exposed to mitomycin C and/or diepoxybutane.
Solid Tumor Cytogenetics: Cytogenetic analysis can be an important adjunct to solid tumor diagnosis and management. This is particularly true in the case of the small round blue cell tumors of childhood (Ewing’s sarcoma/PNET; rhadomyosarcomas).
Tissue Cytogenetics: Solid tissue specimens can be cultured as a source for mitotic cells for chromosomal analysis. Products of conception (POC) specimens from the first trimester spontaneous abortions are often studied. Around half of these are chromosomally abnormal, typically aneuploidies. Tissues from intrauterine fetal demises or stillborns can also be studied and may help confirm abnormal prenatal results. Tissues should be of fetal, not maternal, origin (e.g. fetal tissue, membranes, villi). Internal organs/diaphragm obtained at autopsy can be used. Skin punch biopsies may also be obtained to rule out chromosomal mosaicism or to culture for biochemical and/or molecular analysis.
From this link
Monday, February 11, 2008
How to Host a Bone Marrow Donor Drive
Chances are, if you have a child with Shwachman-Diamond Syndrome, you've considered hosting a bone marrow donor drive. I have just published an article about how our family went about planning and hosting a bone marrow donor drive. You can read it at the following link: How to Host a Bone Marrow Donor Drive
Of course, if you would like to host a bone marrow donor drive and have any questions, please feel free to contact me. You can access my email address from the profile link on this page.
Of course, if you would like to host a bone marrow donor drive and have any questions, please feel free to contact me. You can access my email address from the profile link on this page.
Saturday, February 9, 2008
Elevated MCV
From an MCV Article
Elevated MCV
What might an elevated MCV indicate?
MCV stands for 'mean corpuscular volume', one of the values taken as part of a complete blood count. A group of tests performed on a small amount of blood that provides information about the quantity and quality of each type of blood cell. The MCV is an evaluation of the average volume of each red cell. A high MCV (mean corpuscular volume) is common in MDS and in severe aplastic anemia. MCV is almost invariably elevated also in PNH.
A high MCV is a sign of bone marrow stress in these patients. It does not have independent prognostic significance. It does not warrant treatment per se, unless it is actually due to deficiencies in vitamin B12 or folic acid.
Folic acid or vitamin B12 deficiency should be excluded as causes for the elevated MCV; both of these conditions can cause low blood counts. An increased rate of red blood cell distruction (hemolysis)should also be excluded by checking the reticulocyte count(reticulocytes are larger than mature red blood cells). Hemolysis requires specific treatment. If these conditions are excluded, the high MCV can be attributed to the MDS or aplastic anemia.
The oxygen carrying cells in our body. These bring oxygen to our tissues, and are the most numerous of the blood cells. If these conditions are excluded, the high MCV can be attributed to the MDS or aplastic anemia. It is common in both conditions.
Elevated MCV
What might an elevated MCV indicate?
MCV stands for 'mean corpuscular volume', one of the values taken as part of a complete blood count. A group of tests performed on a small amount of blood that provides information about the quantity and quality of each type of blood cell. The MCV is an evaluation of the average volume of each red cell. A high MCV (mean corpuscular volume) is common in MDS and in severe aplastic anemia. MCV is almost invariably elevated also in PNH.
A high MCV is a sign of bone marrow stress in these patients. It does not have independent prognostic significance. It does not warrant treatment per se, unless it is actually due to deficiencies in vitamin B12 or folic acid.
Folic acid or vitamin B12 deficiency should be excluded as causes for the elevated MCV; both of these conditions can cause low blood counts. An increased rate of red blood cell distruction (hemolysis)should also be excluded by checking the reticulocyte count(reticulocytes are larger than mature red blood cells). Hemolysis requires specific treatment. If these conditions are excluded, the high MCV can be attributed to the MDS or aplastic anemia.
The oxygen carrying cells in our body. These bring oxygen to our tissues, and are the most numerous of the blood cells. If these conditions are excluded, the high MCV can be attributed to the MDS or aplastic anemia. It is common in both conditions.
Shwachman-Diamond Syndrome and Bone Marrow
From this website: http://www.pathologyoutlines.com/bonemarrow.html
Shwachman-Diamond syndrome and bone marrow
Rare autosomal recessive childhood stem cell disorder with peripheral cytopenia (particularly neutropenia), ineffective hematopoiesis, and variable marrow cellularity; also pancreatic insufficiency with pancreatic fatty infiltration
Frequency develop aplastic anemia, myelodysplastic syndrome or acute myeloid leukemia
May be a myelodysplastic disorder from inception (Archives 2002;126:1157)
Laboratory: low serum isoamylase
Case reports: with successful bone marrow transplant (Eur J Pediatr 1999;158:995)
Micro-bone marrow: hypocellular; scattered mild dysplastic changes in all cell lines; may have prominent hematogones (Archives 2000;124:1379)
Micro images: histology and immunohistochemistry; various images
Positive stains: p53
Molecular: mutations in Shwachman Bodian Diamond syndrome gene in 90% (Blood 2004;104:3588)
References: Blood 1999;94:3048, Archives 2002;126:452, OMIM 260400, eMedicine, Wikipedia
Shwachman-Diamond syndrome and bone marrow
Rare autosomal recessive childhood stem cell disorder with peripheral cytopenia (particularly neutropenia), ineffective hematopoiesis, and variable marrow cellularity; also pancreatic insufficiency with pancreatic fatty infiltration
Frequency develop aplastic anemia, myelodysplastic syndrome or acute myeloid leukemia
May be a myelodysplastic disorder from inception (Archives 2002;126:1157)
Laboratory: low serum isoamylase
Case reports: with successful bone marrow transplant (Eur J Pediatr 1999;158:995)
Micro-bone marrow: hypocellular; scattered mild dysplastic changes in all cell lines; may have prominent hematogones (Archives 2000;124:1379)
Micro images: histology and immunohistochemistry; various images
Positive stains: p53
Molecular: mutations in Shwachman Bodian Diamond syndrome gene in 90% (Blood 2004;104:3588)
References: Blood 1999;94:3048, Archives 2002;126:452, OMIM 260400, eMedicine, Wikipedia
Bone Marrow Cellularity
I have loads of medical textbooks on my shelves. Some people buy clothes, I buy books! I have a wonderful book titled: Illustrated Pathology of the Bone Marrow This is what it has to say about the cellularity of the bone marrow:
“It is often easiest to evaluate a bone marrow specimen by comparing it to what would be expected in the normal bone marrow. The initial evaluation on low magnification includes the assessment of sample adequacy and marrow cellularity. The latter is usually based on the biopsy. Estimates of cellularity on aspirate material have been described but may be unreliable in variably cellular marrows. The normal cellularity varies with age and evaluation of cellularity must always be made in the context of the patient’s age. The marrow is approximately 100% cellular during the first three months of life, 80% cellular in children through the age 10 years; it then slowly declines in cellularity until age 30 years, when it remains about 50%cellular. The usually accepted range of cellularity in normal adults is 40-70%. The marrow cellularity declines again in elderly patients to about 30% at 70 years. Because of the variation in cellularity by age, the report should clearly indicate whether the stated cellularity in a given specimen is normocellular, hypocellular or hypercellular.”
I also found this information on a website. http://www.pathologyoutlines.com/bonemarrow.html
Age related changes in bone marrow
Cellularity averages 79% at ages 0-9 years vs. 50% at ages 30-69 vs. 29% at ages 70-79. With aging, hematopoietic tissue is replaced by fat. Deeper medullary areas are typically more cellular than subcortical areas.
B cell production declines with age (Curr Opin Immunol 2005;17:463), although the relative abundance of pro-B, pre-B, immature, naive, and mature B cells usually does not change appreciably between ages 24 and 88 years; occasional patients have exceptionally low numbers of lymphocyte precursors (Blood 2003;101:576)
Hypocellularity in elderly marrow may be due to increased apoptosis (Mech Ageing Dev 2000;117:57)
“It is often easiest to evaluate a bone marrow specimen by comparing it to what would be expected in the normal bone marrow. The initial evaluation on low magnification includes the assessment of sample adequacy and marrow cellularity. The latter is usually based on the biopsy. Estimates of cellularity on aspirate material have been described but may be unreliable in variably cellular marrows. The normal cellularity varies with age and evaluation of cellularity must always be made in the context of the patient’s age. The marrow is approximately 100% cellular during the first three months of life, 80% cellular in children through the age 10 years; it then slowly declines in cellularity until age 30 years, when it remains about 50%cellular. The usually accepted range of cellularity in normal adults is 40-70%. The marrow cellularity declines again in elderly patients to about 30% at 70 years. Because of the variation in cellularity by age, the report should clearly indicate whether the stated cellularity in a given specimen is normocellular, hypocellular or hypercellular.”
I also found this information on a website. http://www.pathologyoutlines.com/bonemarrow.html
Age related changes in bone marrow
Cellularity averages 79% at ages 0-9 years vs. 50% at ages 30-69 vs. 29% at ages 70-79. With aging, hematopoietic tissue is replaced by fat. Deeper medullary areas are typically more cellular than subcortical areas.
B cell production declines with age (Curr Opin Immunol 2005;17:463), although the relative abundance of pro-B, pre-B, immature, naive, and mature B cells usually does not change appreciably between ages 24 and 88 years; occasional patients have exceptionally low numbers of lymphocyte precursors (Blood 2003;101:576)
Hypocellularity in elderly marrow may be due to increased apoptosis (Mech Ageing Dev 2000;117:57)
Bone Marrow Cellularity
I used to be the newsletter coordinator for SDSI. While doing their newsletter, we had an Ask the Doctor section. The folowing comes from the SDSI Summer 2000 newsletter:
“ASK THE DOCTOR
Q: Can you explain what the normal cellularity of bone marrow is at various ages and how cellularity is determined?
A: Bone marrow cellularity decreases with age, by approximately 10% per decade. Thus, the marrow of a newborn infant is practically 100% cellular and that of a 50year old is approximately 50% cellular. Meaning the space is occupied by fat, which increases with age. These percents are obtained from bone marrow biopsies, by examination under the microscope and very roughly estimating how much of the area in the microscope field has cells compared to fat. THEY ARE VERY ROUGH FIGURES!
Blanche Alter, MD “
“ASK THE DOCTOR
Q: Can you explain what the normal cellularity of bone marrow is at various ages and how cellularity is determined?
A: Bone marrow cellularity decreases with age, by approximately 10% per decade. Thus, the marrow of a newborn infant is practically 100% cellular and that of a 50year old is approximately 50% cellular. Meaning the space is occupied by fat, which increases with age. These percents are obtained from bone marrow biopsies, by examination under the microscope and very roughly estimating how much of the area in the microscope field has cells compared to fat. THEY ARE VERY ROUGH FIGURES!
Blanche Alter, MD “
Bone Marrow and Stem Cells
http://www.cancerbacup.org.uk/Treatments/Stemcellbonemarrowtransplants/Generalinformation/Bonemarrowandstemcells
from the link above:
Bone marrow and stem cells
Bone marrow is a spongy material that is found inside the bones (particularly the pelvic bones). Like a factory, bone marrow produces the cells which develop into the three different types of blood cells:
Red blood cells which carry oxygen to all cells in the body. White blood cells which are essential for fighting infection. Platelets which help the blood to clot and prevent bleeding. Stem cells are blood cells at the earliest stage of development in the bone marrow. Within the bone marrow stem cells develop into the different blood cells described above. When the cells are fully mature they are released into the bloodstream.
Normally, most of the stem cells in the body are in the bone marrow and there are only very small numbers in the bloodstream. However, it is possible to stimulate the stem cells to move into the bloodstream, by using low doses of certain chemotherapy drugs or injections of proteins known as growth factors. Stem cells can be collected from the bone marrow or from the bloodstream.
Throughout this section, we use the term 'bone marrow' to mean stem cells which are obtained from the bone marrow, and the term 'stem cell' to mean stem cells obtained from the blood. These are the terms doctors often use. In fact, in both cases it is blood stem cells that are being collected.
from the link above:
Bone marrow and stem cells
Bone marrow is a spongy material that is found inside the bones (particularly the pelvic bones). Like a factory, bone marrow produces the cells which develop into the three different types of blood cells:
Red blood cells which carry oxygen to all cells in the body. White blood cells which are essential for fighting infection. Platelets which help the blood to clot and prevent bleeding. Stem cells are blood cells at the earliest stage of development in the bone marrow. Within the bone marrow stem cells develop into the different blood cells described above. When the cells are fully mature they are released into the bloodstream.
Normally, most of the stem cells in the body are in the bone marrow and there are only very small numbers in the bloodstream. However, it is possible to stimulate the stem cells to move into the bloodstream, by using low doses of certain chemotherapy drugs or injections of proteins known as growth factors. Stem cells can be collected from the bone marrow or from the bloodstream.
Throughout this section, we use the term 'bone marrow' to mean stem cells which are obtained from the bone marrow, and the term 'stem cell' to mean stem cells obtained from the blood. These are the terms doctors often use. In fact, in both cases it is blood stem cells that are being collected.
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