Hematology Lecture Bone Marrow and Anemias

3.4%-5.9%

The body weight that comes from bone marrow

6 billion

The number of blood cells per kilogram produced per day

Yellow Marrow

Retains the ability to revert to active hematopoiesis during necessary demand

Neoplasia diagnosis

Acute leukemias, myeloproliferative neoplasms, myelodysplastic neoplasms, etc.

Neoplasia diagnosis and staging

Hodkin lymphoma, non-hodgkin lymphoma

Cytopenia (marrow failure)

Pure red cell aplasia, myeldysplastic neoplasms, etc.

Metabolic disorders

Gauncher disease, mast cell disease

Infections

Granulomatous disease, miliary tuberculosis, fungal infections, hemophagocytic syndromes

Posterior supperior iliac crest (collection site)

Provides adequate red marrow & isolated from anatomic structures that could be damaged

Anterior superior iliac crest (collection site)

Same advantages as posterior but cortical bone is thicker

Sternum (collection site)

Provides ample material for aspiratoin for adults but only 1cm thick so cannot do biopsy

Anterior medial surface of the tibia (collection site)

Only in infants younger than 1 year old producing only aspirate

Spinous process of the vertebra, ribs, or other red marrow (collection site)

Rarely uses unless site of suspicious lesion

Core biopsy

Collected first to keep aspirate from destroying marrow architecture but there is no gold standard as to which is done first

Aspiraiton procedure

1.0-1.5mL of aspirate is collected into a syringe, as any more than 1.5mL dilutes the hematopoietic marrow; the contents is then expelled onto a series of clean and sterile microscope slides or coverslips

Core Biopsy Imprints (Touch Preparations)

Core biopsy and clotted marrow are held in sterile forceps and repeated touched to a washed glass slide or cover slip; valuable when specimen is clotted or a dry tap & cell morphology may resemble that of aspirate except for the lack of spicules presence of

Stains for Marrow aspirate smears & core biopsy sections

Wright or wright-giemsa stains; differentials but may need to increase staining time due to thickness

Hematoxylin & eosin stain

Used for cytology

Potassium ferrocyanide (prussian blue) stain

Storage iron or iron metabolism abnormalities

Anemia

A decrease in the oxygen-carrying capacity of the blood

Classical symptoms of anemia

Fatigue and shortness of breath

Patient History of Anemia

Diet, drug ingestion, exposure to chemicals, occupation, hobbies, travel, bleeding history, race/ethnic groups, family history, neurologic symptoms, previous medications, previous episodes of jaundice, & underlying disease processes

Moderate Anemia

Hgb 7-10g/dL ; pallor of conjunctivae and nail beds but other symptoms can depend on patient’s age

Severe anemia

Hgb <7g/dL ; tachycardia, hypotension, and other symptoms of volume loss

Acute blood loss (hemorrhage)

Respond with profound changes in physiologic process to ensure adequate perfusion of vital organs & maintenance of hemostasis

Severe acute blood loss (trauma)

Increased heart rate, respiratory rate, & cardiac output wile blood is sent to organs key to survival

Ineffective erythropoiesis

Production of erythroid precursors cells that are defective and often undergo apoptosis in the bone marrow

Insufficient erythropoiesis

Decrease in the number of erythroid precursors in the bone marrow resulting in a decrease in RBC production & anemia

Microcytic Anemias

MCV <80fL ; conditions that result in reduced hemoglobin synthesis such as iron deficiency, iron sequestration, & defective protoporphyrin synthesis

Macrocytic anemias

MCV > 100fL ; conditions that impair synthesis of DNA such as vitamin B12 & folate deficiency or myelodysplasia

Normocytic anemias

MCV 80-100fL ; must rule out dimorphic population consisting of micro and macrocytes which yields a normal MCV