This is a video I put together from pictures and videos from my boys' bone marrow biopsy day- it's got some fun stuff, but has graphic bone marrow biopsy pics at the end. As of 2013, each of my boys has had over 25 BMBs each.
Showing posts with label bone marrow biopsy. Show all posts
Showing posts with label bone marrow biopsy. Show all posts
Saturday, November 9, 2013
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
Thursday, March 6, 2008
Bone Marrow Biopsy Day: What to Expect. How to Survive.
Bone Marrow Biopsy Day. What to Expect. How to Survive. Written by a mom, this article explains what a bone marrow biopsy is, how the procedure is performed and what you can expect while at the hospital.
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)
Tuesday, March 4, 2008
Hematopathology Index
The site below has a library of cells/findings on peripheral blood smears and bone marrow biopsies that may be of interest to SDS families.
http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html
http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html
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
Saturday, March 1, 2008
FISH Testing Info
Fluorescence in situ hybridization
In situ hybridization (ISH) is used to visualize defined nucleic acid sequences in cellular preparations by hybridization of complementary probe sequences. Probe sequences can be labeled with isotopes, but nonisotopic ISH is used increasingly as it is considerably faster, usually has greater signal resolution, and provides many options to simultaneously visualize different targets by combining various detection methods. The most popular protocols use fluorescence detection, as described here. These protocols have many applications, from basic gene mapping and diagnosis of chromosomal aberrations, to detailed studies of cellular structure and function, such as the painting of chromosomes in three-dimensionally preserved nuclei. This protocol describes fluorescence in situ hybridization (FISH) of biotin- or digoxigenin-labeled probes to denatured metaphase chromosomes and interphase nuclei. The hybridized probes are detected and visualized using fluorochrome-conjugated reagents.
This comes from the link below:
FISH
In situ hybridization (ISH) is used to visualize defined nucleic acid sequences in cellular preparations by hybridization of complementary probe sequences. Probe sequences can be labeled with isotopes, but nonisotopic ISH is used increasingly as it is considerably faster, usually has greater signal resolution, and provides many options to simultaneously visualize different targets by combining various detection methods. The most popular protocols use fluorescence detection, as described here. These protocols have many applications, from basic gene mapping and diagnosis of chromosomal aberrations, to detailed studies of cellular structure and function, such as the painting of chromosomes in three-dimensionally preserved nuclei. This protocol describes fluorescence in situ hybridization (FISH) of biotin- or digoxigenin-labeled probes to denatured metaphase chromosomes and interphase nuclei. The hybridized probes are detected and visualized using fluorochrome-conjugated reagents.
This comes from the link below:
FISH
FISH Definition
From NCI:
fluorescence in situ hybridization (floor-EH-sents in SY-too HY-brih-dih-ZAY-shun)
A technique used to look at chromosomes (the parts of the cell that contain genetic information in the form of DNA) or genes (specific regions of DNA in chromosomes that make RNA and proteins). Pieces of DNA containing a fluorescent dye are made in the laboratory and added to cells on a glass slide. When viewed under a microscope with a special light source, parts of chromosomes or genes that bind the pieces of DNA show up as colored. Also called FISH.
fluorescence in situ hybridization (floor-EH-sents in SY-too HY-brih-dih-ZAY-shun)
A technique used to look at chromosomes (the parts of the cell that contain genetic information in the form of DNA) or genes (specific regions of DNA in chromosomes that make RNA and proteins). Pieces of DNA containing a fluorescent dye are made in the laboratory and added to cells on a glass slide. When viewed under a microscope with a special light source, parts of chromosomes or genes that bind the pieces of DNA show up as colored. Also called FISH.
FISH Testing
FISH stands for Fluorescence In-Situ Hybridizaton. Most people with SDS have FISH testing done on their bone marrow sampls when they have their bone marrow biopsies. FISH cn also be done on peripheral blood samples.
FISH
Site above has an illustration, recorded explanation and written definition.
FISH Fact Sheet
FISH
Site above has an illustration, recorded explanation and written definition.
FISH Fact Sheet
Thursday, February 28, 2008
Routine microscopic exam: Any samples taken (blood, bone marrow, or cerebrospinal fluid) are examined under a microscope by a pathologist (doctor specializing in diagnosis of disease by laboratory tests) and are often also reviewed by the patient's hematologist/oncologist (doctor specializing in medical treatment of cancer and blood diseases).
Based on the bone marrow cells’ size, shape, and granules, doctors can classify them into specific types. A key element of this cell classification is whether the cells appear mature (resembling normal cells of circulating blood) or immature (lacking features of normal circulating blood cells). The most immature cells are called blasts.
The percentage of cells in the bone marrow that are blasts is particularly important. Having at least 20% blasts in the marrow is generally required for a diagnosis of acute myeloid leukemia. IAMLcan also be diagnosed if the blasts have a chromosome change that occurs only in a specific type of AML, even though the blast percentage doesn’t reach 20%. In order for a patient to be considered to be in remission after treatment, the blast percentage must be no higher than 5%.
Sometimes this examination does not provide a definite answer, and other lab tests are needed.
Cytochemistry: Cytochemistry studies involve placing cells from the sample on glass microscope slides, then exposing them to chemical stains (dyes) that are attracted to or react with only some types of leukemia cells. These stains cause color changes that can be seen only under a microscope. For example, one stain distinguishes AML from acute lymphocytic leukemia (ALL). The stain causes the granules of most AML cells to appear as black spots under the microscope, but it does not cause ALL cells to change colors.
Flow cytometry: This technique is often used to examine the cells from bone marrow and blood samples. It is very accurate in determining the exact type of leukemia.
Leukemia cells can be distinguished by the kinds of molecules on their surface. A sample of cells is treated with special antibodies which stick to the cells only if certain molecules are present on their surfaces. The cells are then passed in front of a laser beam. If the sample contains cells that now have antibodies attached to them, the laser will cause them to give off light, which is measured and analyzed by a computer. Groups of cells can be separated and counted by these methods.
Immunocytochemistry: During this test, as in flow cytometry, cells from the bone marrow aspiration or biopsy sample are treated with special antibodies that react only to certain molecules. But instead of using a laser and computer for analysis, the sample is treated so that certain types of cells change color. The color change can be seen only under a microscope. Like flow cytometry, it is helpful in distinguishing different types of leukemia from one another and from other diseases.
Cytogenetics: These tests involve looking at a cell’s chromosomes under a microscope. Normal human cells contain 46 chromosomes, pieces of DNA that control cell growth and metabolism.
In certain types of leukemia, 2 chromosomes may exchange some of their DNA, so that part of one chromosome becomes attached to part of a different chromosome. This change, called a translocation, can usually be seen under a microscope. Other changes in chromosomes, such as inversions, deletions, or additions, are also possible. Recognizing these changes helps to identify certain types of AML and is important in determining the outlook for the patient.
The testing usually takes about 3 weeks, because the leukemic cells must grow in laboratory dishes for a couple of weeks before their chromosomes are ready to be viewed under the microscope. The results of cytogenetic testing are written in a shorthand form that describes which chromosome changes are present.
A translocation, written as t(1;2), for example, means a part of chromosome 1 is now located on chromosome 2 and vice versa.
An inversion, written as inv(16), for example, means that part of the chromosome 16 is upside down and is now in reverse order but is still attached to the chromosome it originated from.
A deletion, written as del(7) or -7, for example, indicates part of chromosome 7 has been lost.
An addition, +8, for example, means that all or part of chromosome 8 has been duplicated, and too many copies of it are found within the cell.
Molecular genetic studies: Special tests of leukemia cell DNA can also find most translocations that are visible under a microscope in cytogenetic tests, as well as some translocations too small to be seen with usual cytogenetic testing under a microscope.
This sophisticated testing, called FISH (fluorescent in situ hybridization), is helpful in classifying leukemia because many subtypes of AML have distinctive translocations. Information about these translocations may be useful in predicting how the patient will respond to treatment.
These tests may also be used after treatment to find small numbers of leukemia cells that can be missed under a microscope.
Based on the bone marrow cells’ size, shape, and granules, doctors can classify them into specific types. A key element of this cell classification is whether the cells appear mature (resembling normal cells of circulating blood) or immature (lacking features of normal circulating blood cells). The most immature cells are called blasts.
The percentage of cells in the bone marrow that are blasts is particularly important. Having at least 20% blasts in the marrow is generally required for a diagnosis of acute myeloid leukemia. IAMLcan also be diagnosed if the blasts have a chromosome change that occurs only in a specific type of AML, even though the blast percentage doesn’t reach 20%. In order for a patient to be considered to be in remission after treatment, the blast percentage must be no higher than 5%.
Sometimes this examination does not provide a definite answer, and other lab tests are needed.
Cytochemistry: Cytochemistry studies involve placing cells from the sample on glass microscope slides, then exposing them to chemical stains (dyes) that are attracted to or react with only some types of leukemia cells. These stains cause color changes that can be seen only under a microscope. For example, one stain distinguishes AML from acute lymphocytic leukemia (ALL). The stain causes the granules of most AML cells to appear as black spots under the microscope, but it does not cause ALL cells to change colors.
Flow cytometry: This technique is often used to examine the cells from bone marrow and blood samples. It is very accurate in determining the exact type of leukemia.
Leukemia cells can be distinguished by the kinds of molecules on their surface. A sample of cells is treated with special antibodies which stick to the cells only if certain molecules are present on their surfaces. The cells are then passed in front of a laser beam. If the sample contains cells that now have antibodies attached to them, the laser will cause them to give off light, which is measured and analyzed by a computer. Groups of cells can be separated and counted by these methods.
Immunocytochemistry: During this test, as in flow cytometry, cells from the bone marrow aspiration or biopsy sample are treated with special antibodies that react only to certain molecules. But instead of using a laser and computer for analysis, the sample is treated so that certain types of cells change color. The color change can be seen only under a microscope. Like flow cytometry, it is helpful in distinguishing different types of leukemia from one another and from other diseases.
Cytogenetics: These tests involve looking at a cell’s chromosomes under a microscope. Normal human cells contain 46 chromosomes, pieces of DNA that control cell growth and metabolism.
In certain types of leukemia, 2 chromosomes may exchange some of their DNA, so that part of one chromosome becomes attached to part of a different chromosome. This change, called a translocation, can usually be seen under a microscope. Other changes in chromosomes, such as inversions, deletions, or additions, are also possible. Recognizing these changes helps to identify certain types of AML and is important in determining the outlook for the patient.
The testing usually takes about 3 weeks, because the leukemic cells must grow in laboratory dishes for a couple of weeks before their chromosomes are ready to be viewed under the microscope. The results of cytogenetic testing are written in a shorthand form that describes which chromosome changes are present.
A translocation, written as t(1;2), for example, means a part of chromosome 1 is now located on chromosome 2 and vice versa.
An inversion, written as inv(16), for example, means that part of the chromosome 16 is upside down and is now in reverse order but is still attached to the chromosome it originated from.
A deletion, written as del(7) or -7, for example, indicates part of chromosome 7 has been lost.
An addition, +8, for example, means that all or part of chromosome 8 has been duplicated, and too many copies of it are found within the cell.
Molecular genetic studies: Special tests of leukemia cell DNA can also find most translocations that are visible under a microscope in cytogenetic tests, as well as some translocations too small to be seen with usual cytogenetic testing under a microscope.
This sophisticated testing, called FISH (fluorescent in situ hybridization), is helpful in classifying leukemia because many subtypes of AML have distinctive translocations. Information about these translocations may be useful in predicting how the patient will respond to treatment.
These tests may also be used after treatment to find small numbers of leukemia cells that can be missed under a microscope.
Saturday, February 16, 2008
Bone Marrow Biopsy Day
Bone Marrow Biopsy Day
A book for children who are facing a bone marrow biopsy. The idea for this book came from a scrapbook Pattie made for her two sons with Shwachman-Diamond Syndrome who have had over fifteen bone marrow biopsies each. Her youngest son, Joseph, always wanted to know what happened to him once he fell asleep in the OR. Once the first book was made for her children, a Child Life Specialist suggested that the book could help other families dealing with similar issues. A few changes later and this book was a reality. This edition includes a section for parents on helping children cope with medical procedures and other helpful topics for families dealing with chronic illness
A book for children who are facing a bone marrow biopsy. The idea for this book came from a scrapbook Pattie made for her two sons with Shwachman-Diamond Syndrome who have had over fifteen bone marrow biopsies each. Her youngest son, Joseph, always wanted to know what happened to him once he fell asleep in the OR. Once the first book was made for her children, a Child Life Specialist suggested that the book could help other families dealing with similar issues. A few changes later and this book was a reality. This edition includes a section for parents on helping children cope with medical procedures and other helpful topics for families dealing with chronic illness
Saturday, February 9, 2008
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 “
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