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Normal Bone Marrow

Aug 27, 202312 min read

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Normal Bone Marrow

Pronormoblast (proerythroblast)

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  • 紅細胞系統中最 ✖ 不成熟和最大的 → 細胞
  • 細胞大小為 12-24 微米
  • 核質比 (N / C) 比率相對較高 (7-8：1)
  • 核形狀圓形至略呈卵形
  • 染色質網狀，細緻
  • 核仁明顯 (≥1)
  • 細胞質為 ✖ 無顆粒嗜鹼性
  • The most immature and largest cells in erythroid lineage (12-24 μm), relatively high nuclear to cytoplasmic (N/C) ratio (7-8:1), round to slightly oval nucleus, finely reticulated chromatin, prominent nucleoli (≥ 1), and agranular basophilic cytoplasm

Basophilic normoblast

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  • 比起原始紅細胞，較小的 → 細胞 (10-17 微米)
  • 核形狀圓形
  • 核質比高 (6：1)
  • 染色質開放至稍微緊密
  • 明顯的 → 副染色質
  • 後期核仁很少可見或 ✖ 不見
  • 細胞質為深嗜鹼性
  • Smaller cells (10-17 μm) than pronormoblast, round nucleus, high N/C ratio (6:1), open to slightly condensed chromatin, distinct parachromatin, rarely visible or absent nucleoli in later stage, and deep basophilic cytoplasm

Polychromatophilic normoblast

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  • 比起嗜酸性正紅母細胞，較小的 → 細胞 (10-15 微米)
  • 核質比較低 (4：1)
  • 圓形的 → 核具有緊密的 → 染色質
  • 經常出現車輪狀外觀
  • 可見周核光暈
  • 沒有核仁
  • 細胞質為藍灰色至粉灰色
  • Smaller cells (10-15 μm) and lower N/C ratio (4:1) than basophilic normoblasts, round nucleus with condensed chromatin, often cartwheel appearance, visible perinuclear halo, no nucleoli, and blue-gray to pink-gray cytoplasm

Orthochromic normoblast

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  • 比起多色性正紅母細胞，細胞更成熟且更小 (8-12 微米)
  • 細胞質豐富 (核質比 1:2)
  • 顏色與紅細胞類似，呈粉橙色至極少嗜鹼性的 → 顏色
  • 圓形的 → 核
  • 染色質密集或縮核
  • More mature and smaller cells (8-12 μm) than polychromatophilic normoblast, abundant cytoplasm (N/C ratio 1:2) with pink-orange and minimally basophilic color similar to erythrocytes, round nucleus, and densely condensed or pyknotic chromatin

Erythrocyte

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  • 最成熟的 → 細胞 (7-8.5 微米)
  • 呈粉橙色至鮭色
  • 沒有核
  • The most mature cells (7-8.5 μm), pink-orange to salmon color, and no nucleus

Myeloblast

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  • 顆粒細胞系統中最 ✖ 不成熟的 → 細胞 (15-20 微米)
  • 核質比高 (4-7：1)
  • 圓形至卵形的 → 核
  • 細緻至網狀的 → 染色質
  • 有明顯的 → 核仁 (1-5)
  • 細胞質中等嗜鹼性
  • 沒有或極少有嗜碱性顆粒
  • The most immature granulocytic cells (15-20 μm), with high N/C ratio (4-7:1), round to oval nucleus, fine to reticular chromatin with distinct nucleoli (1-5), and moderately basophilic cytoplasm with absent or minimal azurophilic granules

Promyelocyte

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  • 略大於骨髓母細胞的 → 細胞 (14-24 微米)
  • 核質比高 (3-5：1)
  • 偏心圓形至卵形的 → 核
  • 稍微粗糙或細網狀的 → 染色質
  • 明顯的 → 核仁 (1-3)
  • 嗜鹼性細胞質帶有周核長凸起
  • 突出的 → 嗜碱性 (原始) 顆粒，有時覆蓋在核上
  • Slightly larger cells (14-24 μm) than myeloblasts, with high N/C ratio (3-5:1), eccentric round to oval nucleus, slightly coarse or finely reticular chromatin, distinct nucleoli (1-3), basophilic cytoplasm with paranuclear hof and prominent azurophilic (primary) granules, which may overlie the nucleus

Myelocyte

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  • 稍小於母細胞的 → 細胞 (10-18 微米)
  • 細胞質更豐富 (核質比 1-2：1)
  • 偏心圓形至卵形的 → 核
  • 染色質更緊密
  • 沒有核仁
  • 細胞質藍色至粉紅色，帶有周核凸起
  • 豐富的 → 淡紫色 (次級) 顆粒
  • 分散少量嗜碱性 (原始) 顆粒
  • Slightly smaller cells (10-18 μm) than blasts, with more abundant cytoplasm (N/C ratio 1-2:1), eccentric round to oval nucleus, more condensed chromatin, no nucleoli, bluish to pink cytoplasm with paranuclear hof, abundant lilac (secondary) granules, and scattered few azurophilic (primary) granules

Metamyelocyte

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  • 大小與骨髓細胞相似或稍小 (10-18 微米)
  • 細胞質豐富 (核質比 1-1.5：1)
  • 凹陷或腎形核 (凹陷小於核邊緣寬度的 → 一半)
  • 染色質緊密
  • 沒有核仁
  • 略帶粉紅色的 → 細胞質
  • 有許多次級顆粒和少量原始顆粒
  • Size similar to or slightly smaller (10-18 μm) than myelocytes, with abundant cytoplasm (N/C ratio 1-1.5:1), indented or kidney-shaped nucleus (indentation less than half the width of the nuclear margin), condensed chromatin, no nucleoli, pinkish cytoplasm with many secondary granules and rare primary granules

Band neutrophil

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  • 與中嗜細胞相似的 → 較成熟細胞 (10-18 微米)
  • 細胞質豐富 (核質比 1：1.2-1.5)
  • 凹陷、帶狀或香腸狀核 (凹陷超過核邊緣寬度的 → 一半)
  • 染色質緊密
  • 沒有核仁
  • 略帶粉紅色的 → 細胞質
  • 有豐富的 → 次級顆粒
  • More mature cells (10-18 μm) similar to metamyelocytes, abundant cytoplasm (N/C ratio 1:1.2-1.5), indented or band-like or sausage-like nucleus (indentation more than half the width of the nuclear margin), condensed chromatin, no nucleoli, and pinkish cytoplasm with abundant secondary granules

Segmented neutrophil

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  • 最成熟的 → 細胞 (10-18 微米)
  • 細胞質豐富
  • 染色質更緊密
  • 核有 3 至 5 個明顯的 → 葉片，由細長的 → 絲狀物連接
  • 略帶粉紅色的 → 細胞質充滿次級顆粒
  • The most mature cells (10-18 μm), with abundant cytoplasm, more condensed nucleus with 3 to 5 distinct lobes connected by thin filaments, and pinkish cytoplasm packed with secondary granules

Immature megakaryocyte

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  • Smaller cell (size > 20 μm) than mature megakaryocytes, with high N/C ratio, one round lobe, horseshoe-shaped or slightly lobulated nucleus, variably clumped chromatin, and deeply basophilic cytoplasm with cytoplasmic blebbing

Mature megakaryocyte

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  • The largest hematopoietic cells (20-160 μm) with variable size and shape, more abundant pink cytoplasm with abundant azurophilic granules, and highly folded and connected nuclei with multilobation (2-16 lobes) on later stage of maturation, clumped chromatin, and no nucleoli

Platelet

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  • The most mature and smallest (2-4 μm) megakaryocytic cells, with pale to gray-blue cytoplasm, no nucleus, and dispersed purple to red azurophilic granules

fig.1.1

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  • 檢體質量良好，大小適中，有皮質骨和幾個骨小梁間隙含有造血細胞和脂肪細胞
  • 骨髓細胞密度是通過造血細胞在骨髓空間總體積中的 → 百分比來估算的
  • 隨年齡增長而下降 ↓ ，嬰兒或幼兒具有最高的 → 細胞密度，老年人最低
  • 在這張幻燈片上，骨髓空間約佔 90％的 → 細胞密度是由造血細胞佔據，大約 10％是脂肪細胞
  • 這是 4 歲孩子正常的 → 細胞密度

Fig. 1.2

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  • 女性，42 歲
  • 骨髓空間約佔 50-60%的 → 造血細胞有三線造血功能
  • 約佔 40-50%的 → 脂肪細胞，符合 42 歲正常細胞度

Fig. 1.3

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  • 男性，78 歲
  • 骨髓空間約佔 20%的 → 造血細胞明顯減少
  • 約佔 80%的 → 脂肪細胞增多
  • 細胞度符合 78 歲正常範圍

Fig. 1.4

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  • 紅系前驅細胞成熟階段 ✖ 不同

  • 兩個最大的 → 細胞 (黑色箭頭) 為原幼紅球 (pronormoblasts 或 proerythroblasts)，是最 ✖ 不成熟的 → 紅系細胞，其細胞質強烈嗜鹼性，核大且染色質 ✖ 不成熟，有少數明顯核仁

  • 嗜鹼性正幼紅球 (紅色箭頭) 為下一個成熟階段的 → 紅系細胞，比原幼紅球小，∵ 由於 RNA 豐富而呈嗜鹼性細胞質，染色質稍為凝聚，有可見的 → 核仁

  • 底部的 → 兩個細胞 (藍色箭頭) 為多染色性正幼紅球，與嗜鹼性正幼紅球的 → 區別在於細胞更小，細胞質呈灰色，與血紅蛋白的 → 積聚有關，染色質明顯凝聚成團，✖ 無核仁

  • 亦顯示一個成熟淋巴球

  • Bone marrow aspirate smear shows various stages of matura- tion in erythroid precursors.

  • The two largest cells (black arrow) are pronormoblasts (or proerythroblasts), the most immature erythroid cells, which are characterized by intensely basophilic cytoplasm, a large nucleus with immature chromatin, and few prominent nucleoli.

  • A basophilic normoblast (red arrow), the cell in the next stage of ery- throid maturation, is → smaller than pronormoblasts but has basophilic cytoplasm owing to abundant RNA, slightly condensed chromatin, and visible nucleoli.

  • Two cells in the bottom (blue arrow) are polychro- matophilic normoblasts, which can be differentiated from basophilic normoblasts by their smaller size, gray cytoplasmic color related to an accumulation of hemoglobin, significantly condensed chromatin with clumping, and absent nucleoli.

  • A mature lymphocyte is → also shown

Fig 1.5

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  • (A) 嗜鹼性正幼紅球
  • (B) 多染色性正幼紅球
  • (C) 直染色正幼紅球
  • 隨著紅系前驅細胞成熟，細胞質逐漸從深藍色到灰藍色到粉橙色，染色質的 → 成熟進展從 ✖ 不太凝聚到明顯凝聚到非常緊密和均勻的 → 染色質，且細胞大小稍有減少
  • (註：basophilic normoblast 為嗜鹼性正幼紅球，polychromatophilic normoblast 為多染色性正幼紅球，orthochromic normoblast 為直染色正幼紅球)

Fig. 1.6

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  • 骨髓空間中有突出的 → 紅系前驅細胞
  • 紅系前驅細胞與其他造血細胞的 → 區別在於其圓形的 → 核輪廓和非常緊密、均勻的 → 核染色質
  • 其他造血細胞正常

Fig 1.8

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骨髓抽取物涂片報告 🧬

  • 顯示了一個早幼粒細胞 (紅色箭頭)，三個幼粒細胞 (黑色箭頭)，四個斷裂型中性粒細胞 ( 💥 沒有箭頭)，以及一個分叶型中性粒細胞 (藍色箭頭)
  • 早幼粒細胞的 → 細胞質嗜鹼性，有一個偏心、圓形至橢圓形的 → 核，可見核仁，核周有顯著、粗糙的 → 嗜鹼性顆粒 (原始顆粒)
  • 幼粒細胞與早幼粒細胞相似或略小，核圓形至橢圓形，核周有高爾基體對應的 → 核周區，染色質更緊密，細胞質由藍色到粉紅色，含有豐富的 → 淡紫色顆粒 (次生顆粒)
  • 斷裂型和分叶型中性粒細胞的 → 核形狀和染色質 ✖ 不同，分叶型中性粒細胞的 → 核染色質更緊密凝聚，核分叶由細長的 → 細絲相連，而斷裂型中性粒細胞的 → 核則呈帶狀、香腸狀、C 形或 U 形 (註：promyelocyte 為早幼粒細胞，myelocytes 為幼粒細胞，band neutrophils 為斷裂型中性粒細胞，segmented neutrophil 為分叶型中性粒細胞)

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