DOCSLIB.ORG

Bone Marrow Pathology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Bone Marrow Pathology Bone marrow pathology Educational course, Belgian Society of Hematology 18 Nov 2017 Dr. J. Somja, CHU Sart Tilman, Liège, [email protected] Learning objectives When ? Bone Why ? marrow What ? examination How ? I. When ? Indications for BM examination Indications for BM examination • Haematological abnormalities that cannot be explained by available clinical and laboratory data. • A good indication is essential for an accurate diagnosis • 3 main indications : – Diagnostic purposes – Staging for malignant diseases – Monitoring Riley et al., JCLA, 2004 II. What? What specimens to collect ? (Bone marrow Particle clot) BONE MARROW Bone marrow aspirate Bacteriology Bone marrow trephine biopsy if necessary Smear Preparation + Heparin +EDTA Heparin FFPE 2-10 days Molecular Morpho, IHC, Flow biology Cytogenetics FISH, (clonal cytometr (clonal days-weeks expansion, NGS) y expansion, Karyotyping (hours) NGS, …) BM biopsy MGG Cyto- FISH Days-Weeks FISH cytology chemistr If necessary touch imprint (hours) y (hours) (days) (hours) Usefull if dry tap BM aspirate or trephine biopsy ? BM ASPIRATE BM BIOPSY • Quick results • Complete assessement of • Fine cytological detail cellularity and architecture • Enumeration of marrow • More sensitive for focal cellular elements lesions • Wider cytochemical stains • Allows grading of fibrosis can be used • Use of IHC • Ideal for flow cytometry, • Useful for assessment of cytogenetics/molecular AA, metastasis, some studies infections BM aspirate or trephine biopsy ? A thorough bone marrow examination includes both BM aspiration and trephine biopsy. – MDS: BM aspirate >>> BM biopsy – MPN: BM aspirate = BM biopsy – MPN/MDS BM aspirate > BM biopsy – AML: BM aspirate >>> BM biopsy – NHL: BM aspirate << BM biopsy – HL: BM aspirate <<< BM biopsy – MM: BM aspirate < BM biopsy – Carcinoma: BM aspirate << BM biopsy III. How? How to collect these specimens ? 1. Anatomic sites 2. Collection procedure 3. Adequacy Anatomic sites • Crest of the posterior superior iliac spine – Preferred site • Sternum – Experienced operator – Only marrow aspiration ! – Not in MM • Anterior superior iliac spine – Rarely performed • Anterior tibial plateau – Very young children Riley et al., JCLA, 2004 Collection procedure BM aspirate adequacy • Adequate aspirate – 6-12 slides – Bone marrow particles ! – Not crushed – Not too thick – Not clotted – Allow to dry quickly – Dry tapes represent 2-7% of the cases – If an adequate aspirate has not been possible, considerations should be given to preparing touch imprints of the core biopsy prior to placing it in fixative BM Aspirate smears Riley et al., JCLA, 2004 Touch imprints of the core biopsy Riley et al., JCLA, 2004 Touch imprints of the core biopsy Be gentle, be delicate ! Do NOT CRUSH ! Riley et al., JCLA, 2004 Collection procedure BM trephine biopsy adequacy • 11-gauge needle AT LEAST • If osteopenic, a 8-gauge needle allows the collection of an intact core biopsy with minimal crush artifact • 13-gauge biopsy needle for paediatric patients • Adequate core biopsy, – At least 1.6 cm to 2 cm long • Prior to fixation • Exclusive of cortical bone, cartilage, or periosteum • Free of crush artifact or interstitial hemorrhage or fragmentation Riley et al., JCLA, 2004 I. Why? Understanding of the BM examination reports Shemes like this should not have any secrets … BM trephine : Generalities Jaffe, Hematopathology, second edition, 2017 Erythropoïesis Granulopoïesis Courtesy of Pr. Tassin and Dr. Keutgens Jaffe, Hematopathology, second edition, 2017 Mégacaryocytes Other? • Monocytes • Macrophages • Plasma cells • Lymphoid cells • Mast cells • Oestoclasts • Bone • Iron • … Courtesy of Pr. Tassin and Dr. Keutgens Jaffe, Hematopathology, second edition, 2017 Immunohistochemistry • Erythroid: GlycophorinA, LMO2, CD71 • Myeloid: MPO • Megacaryocytes: CD61, Factor VIII • Blasts: CD34, CD117, CD33 – CD34+ cells are rare in normal marrow – CD34 does not equal blast • not all blasts are CD34+ • not all CD34+ cells are blasts – Not all AML’s are CD34+ – CD34 is not lineage specific • Mastocytes: Tryptase, CD117, CD25, CD2 • Plasma cells: CD138, IgKappa, IgLambda • Lymphocytes: CD20, CD3, CD30, … • … Cellularity 100-age = expected cellularity for age Severe AA is characterized by a markedly hypocellular bone marrow (<25% of normal for age or 25 to 50% of normal with <30% hematopoietic cells) accompanied by two of the following: granulocytes <0.5 × 109/L; platelets <20 × 109/L; or corrected reticulocyte count <1% Riley et al., JCLA, 2009 Jaffe, Hematopathology, second edition, 2017 Bone marrow (neoplastic) pathology WHO 2016 Myeloid Neoplasms WHO 2016 Myeloid Neoplasms 1. Myeloproliferative neoplasms • Clonal hematopoietic disorders • Characterized by proliferation of cells of one or more of the myeloid lineages; erythroid, granulocytic, or megakaryocytic • Initially, the proliferation in the bone marrow is effective and associated with maturation of the neoplastic cells • Leads to increased numbers of mature granulocytes, red blood cells (RBCs), and platelets in the peripheral blood • Splenomegaly and hepatomegaly are common and caused by the sequestration of excess blood cells, extramedullary hematopoiesis or both in these organs. Chronic Myeloid Leukaemia, BCR-ABL1+ • Blood findings – Leukocytosis – Plts N or ↗ – Often anaemia – Spectrum of maturing granulocytes with a « myelocyte bulge » – Blasts usually <2% if WBC – Absolute basophilia – No significant dysplasia • BM findings – Hypercellularity – Increased M:E ratio – Blasts usually <5%, always <10% – Widening of maturing granulocytes with myelocyte bulge but no dysplasia – Megs N or ↗ in number, with « dwarf » morphology – Reticulin fibers N to moderately increased • Genetics – 100% have Phi chromosome or BCR-ABL1 fusion gene Courtesy of Pr. Tassin and Dr. Keutgens Jaffe, 2017 Jaffe, 2017 Jaffe, 2017 Jaffe, 2017 Jaffe, 2017 Essential Thrombocytaemia From major mixed to the 4th to minor Jaffe, 2017 Jaffe, 2017 Possible cause of Thrombocytosis • Secondary – Infection – Inflammation and AI diseases – Blood loss, hemorrhage – Chronic iron deficiency – Post-splenectomy – Hyposplenism – Trauma (brain injury) – Post-surgical procedures – Neoplasms (Non-hemato and non-myeloid hemato) – BM regeneration, rebound, following chemotherapy • Myeloid neoplasm related – MPN – CML, BCR-ABL1+ – PV – ET – AML with t(3;3)(q21.3;q26.2) or inv(3)(q21.3q26.2) – MDS with isolated del(5q) abnormaly – MDS/MPN-RS-T Polycythaemia Vera Was >18.5 g/dL Was >16.5 g/dL From minor to major criteria Endogenous erythroid colony formation in vitro Jaffe, 2017 Jaffe, 2017 Jaffe, 2017 Primary Myelofibrosis Jaffe, 2017 Diagnostic criteria of distinctive value regarding WHO-defined ET (left) versus early- prefibrotic stage of PMF (right), including standardized morphologic features (Table 1 contains more details), allowing the generation of characteristic histologic BM patterns Jürgen Thiele et al. Blood 2011;117:5710-5718 ©2011 by American Society of Hematology Jaffe, 2017 Jaffe, 2017 Jaffe, 2017 Bone marrow fibrosis European consensus on grading bone marrow fibrosis and assessment of cellularity. J.Thiele et al. Haematologica 2005; 90:1128-1132 Standard grading Bauermeister 1971; Manoharan et al. 1979 Jaffe, 2017 2. Myelodysplastic syndromes Definition • Sustained unexplained anemia, neutropenia or thrombocyopenia (Hb<10g/dL; Abs. Neutrophil count <1.8 x109 or platelets <100 x109/L) • And at least one of the following – Dysplastic morphology in erythroid cells, granulocytes or megacaryocytes, affecting at least 10% of the cells of at least one of these lineages – Acquired conal MDS-associated cytogenetic abnormality in hematopoïetic cells and absence of de novo AML-defining cytogenetic abnormalities t(15;17), inv (16)/t(16;16) or t(8;21) – Increased blasts (at least 5% of marrow cells) not attributable to exogenous GF administration or transient marrow recovery Acquired conal MDS-associated cytogenetic abnormality Del(20q), +8 and –Y abnormalities, although common findings in MDS, are not considered MDS defining and cannot in isolation be used to make a diagnosis of MDS Dysplastic Erythropoeisis • Nuclear – Nuclear budding – Internuclear bridgking – Karyorrhexis – Multinuclearity – Nuclear hyperlobation – Megaloblastic changes • Cytoplasmic – Ring sideroblasts – Vacuolisation – PAS positivity Jaffe, Hematopathology, 2017 Cantù Rajnoldi et al., Ann Hematol, 2005 Ring Sideroblasts • 3 types of sideroblasts – Type 1 : <5 siderotic granules • Reactive ring sideroblasts – Type 2 :>5 siderotic granules but no perinuclear – distribution Alcohol (plasma cell iron) – Type 3 : Ring sideroblasts : 5 or more perinuclear – Zinc granules in a perinuclear distribution, surrounding the nucleus or at least 1/3 of the nuclear – Pyridoxine deficiency circonference – Drugs (isoniazid, cycloserine) • MPN and MDS/MPN – PMF, ET – MDS/MPN-RS-T • Hereditary – Hereditary sideroblastic anaemia Mufti et al., Haematologica, 2008 Dysplastic Myelopoiesis • Small or unusually large size • Nuclear hypolobation (pseudo-Pelger-Huët; pelgeroid) • Irregular hypersegmentation • Decreased granules; agranularity • Pseudo-Chédiak-Higashi granules • Auer rods Jaffe, Hematopathology, 2017 Cantù Rajnoldi et al., Ann Hematol, 2005 Dysplastic Megacaryotes • Micromegacaryocytes • Nuclear hypolobulation • Multinucleation – Normal megacaryocytes are uninucleate with lobulated nuclei Jaffe, Hematopathology, 2017 Cantù Rajnoldi et al., Ann Hematol, 2005 Hasserjian, XIII EBMWG , 2017 MDS : Pitfalls Non-MDS conditions associated
Load more

Recommended publications
  • Section 8: Hematology CHAPTER 47: ANEMIA
    Section 8: Hematology CHAPTER 47: ANEMIA Q.1. A 56-year-old man presents with symptoms of severe dyspnea on exertion and fatigue. His laboratory values are as follows: Hemoglobin 6.0 g/dL (normal: 12–15 g/dL) Hematocrit 18% (normal: 36%–46%) RBC count 2 million/L (normal: 4–5.2 million/L) Reticulocyte count 3% (normal: 0.5%–1.5%) Which of the following caused this man’s anemia? A. Decreased red cell production B. Increased red cell destruction C. Acute blood loss (hemorrhage) D. There is insufficient information to make a determination Answer: A. This man presents with anemia and an elevated reticulocyte count which seems to suggest a hemolytic process. His reticulocyte count, however, has not been corrected for the degree of anemia he displays. This can be done by calculating his corrected reticulocyte count ([3% × (18%/45%)] = 1.2%), which is less than 2 and thus suggestive of a hypoproliferative process (decreased red cell production). Q.2. A 25-year-old man with pancytopenia undergoes bone marrow aspiration and biopsy, which reveals profound hypocellularity and virtual absence of hematopoietic cells. Cytogenetic analysis of the bone marrow does not reveal any abnormalities. Despite red blood cell and platelet transfusions, his pancytopenia worsens. Histocompatibility testing of his only sister fails to reveal a match. What would be the most appropriate course of therapy? A. Antithymocyte globulin, cyclosporine, and prednisone B. Prednisone alone C. Supportive therapy with chronic blood and platelet transfusions only D. Methotrexate and prednisone E. Bone marrow transplant Answer: A. Although supportive care with transfusions is necessary for treating this patient with aplastic anemia, most cases are not self-limited.
    [Show full text]
  • An Audit- Indications and Diagnosis of Bone Marrow Biopsies at a Tertiary Care Hospital in Saudi Arabia
    Hematology & Transfusion International Journal Research Article Open Access An audit- indications and diagnosis of bone marrow biopsies at a tertiary care hospital in Saudi Arabia Abstract Volume 6 Issue 5 - 2018 Objective: We conducted the study to observe the common indications of bone marrow Fatma Said Al Qahtani, Naveen Naz Syed biopsy and frequencies of various disorders diagnosed on bone marrow examination Department of Pathology, King Khalid University Hospital, in our center. Kingdom of Saudi Arabia Materials and methods: It was a descriptive retrospective audit conducted at the Fatma Said Al Qahtani, MBBS, KSUFpath, Division of Hematology, Department of Pathology at King Khalid University Hospital Correspondence: Assistant Professor and Consultant Hematopathologist, Division in Riyadh. All bone marrow biopsies performed and reported from January 2014 till of Hematology, Department of Pathology, College of Medicine, December 2015 on patients of all age groups and both genders were analyzed. King Saud University, King Khalid University Hospital, Riyadh, Results: Total 481 bone marrows were examined during this two years’ time period. Kingdom of Saudi Arabia, Tel: 00966-568074991, All relevant information were extracted and analyzed including reasons of referral and Email [email protected] provisional diagnosis made by clinicians. Ages ranged from 5 weeks to 99 years old, Received: August 26, 2018 | Published: October 17, 2018 and male to female ratio 1.4:1. The common indication of bone marrow biopsy is for diagnosis and management of acute leukemia, then for staging of lymphoma and work up of pancytopenia. Acute leukemia followed by myeloproliferative diseases was most frequently diagnosed malignant disorders and idiopathic thrombocytopenic purpura was common benign hematological finding on bone marrow examination.
    [Show full text]
  • Multiple Myeloma
    Multiple myeloma What is multiple myeloma? Let us explain it to you. www.anticancerfund.org www.esmo.org ESMO/ACF Patient Guide Series based on the ESMO Clinical Practice Guidelines www.anticancerfund.org www.esmo.org MULTIPLE MYELOMA: A GUIDE FOR PATIENTS PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES This guide for patients has been prepared by the Anticancer Fund as a service to patients, to help patients and their relatives better understand the nature of multiple myeloma and appreciate the best treatment choices available according to the subtype of disease. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of disease. The medical information described in this document is based on the clinical practice guidelines of the European Society for Medical Oncology (ESMO) for the management of multiple myeloma. This guide for patients has been produced in collaboration with ESMO and is disseminated with the permission of ESMO. It has been written by a medical doctor and reviewed by two oncologists from ESMO including the leading author of the clinical practice guidelines for professionals. It has also been reviewed by representatives from the European Oncology Nursing Society (EONS) and the patient representative from ESMO’s Patient Advocates Working Group. More information about the Anticancer Fund: www.anticancerfund.org More information about the European Society for Medical Oncology: www.esmo.org For words marked with an asterisk, a definition is provided at the end of the document. Multiple myeloma: a guide for patients - Information based on ESMO Clinical Practice Guidelines - v.2017.1 Page 1 This document is provided by the Anticancer Fund with the permission of ESMO.
    [Show full text]
  • Bone Marrow Cytology Or Bone Marrow Histology 82131 Gauting, Germany
    Indications for bone marrow examination and Heinz Diem, MD Würmtal-Labor Robert-Koch-Allee 7, decision criteria for bone marrow cytology or bone marrow histology 82131 Gauting, Germany In adults all cells of the peripheral blood are generated in the bone marrow The following table contains the indications for bone marrow cytology Armin Funk, MD (haematopoiesis). They all derive from stem cells that are dividing and either and histology. Gemeinschaftspraxis-Pathologie Lachnerstr. 2, remain stem cells (autoreplication) or become precursors of the different 80639 München, Germany cell lineages. The generation of three main cell lineages are distinguished as + examination is mandatory erythropoiesis, granulopoiesis and thrombopoiesis. For lymphocytes the bone (+) examination is helpful, but not mandatory Torsten Haferlach, MD marrow is also an important compartment. In adults haematopoiesis takes ø examination is usually not indicated Munich Leukemia Laboratory place far from the blood vessels (sinus). With increasing maturity the cells get Max-Lebsche-Platz 31, 81377 München, Germany closer to the sinus. The sinus wall represents a barrier. Normally, only mature cells can enter the peripheral blood (blood-bone marrow barrier). Changes in the Bone marrow Bone marrow Rolf Hinzmann, MD, PhD peripheral blood or cytology histology Sysmex Europe GmbH A bone marrow examination is performed in certain clinical conditions suspected diagnosis (Aspiration) (Biopsy) Bornbarch 1, (e.g. lymphoma) or when findings in the peripheral blood (such as anaemia, 22848 Norderstedt, Germany leukocytosis) are otherwise inexplicable. Otherwise inexplicable + (+) In general there are two different types of bone marrow examination: isolated neutropenia Bone marrow cytology, which requires a bone marrow aspiration, and bone marrow histology, which requires a biopsy.
    [Show full text]
  • BONE MARROW SPECIMEN (ASPIRATE and TREPHINE BIOPSY) STRUCTURED REPORTING PROTOCOL (1St Edition 2014)
    BONE MARROW SPECIMEN (ASPIRATE AND TREPHINE BIOPSY) STRUCTURED REPORTING PROTOCOL (1st Edition 2014) Core Document versions: • World Health Organization Classification of Tumours of Haematopoietic and Lymphoid Tissues, 4th edition, 2008 1 ISBN: 978-1-74187-964-3 Publications number (SHPN): (CI) 140018 Online copyright © RCPA 2014 This work (Protocol) is copyright. You may download, display, print and reproduce the Protocol for your personal, non-commercial use or use within your organisation subject to the following terms and conditions: 1. The Protocol may not be copied, reproduced, communicated or displayed, in whole or in part, for profit or commercial gain. 2. Any copy, reproduction or communication must include this RCPA copyright notice in full. 3. With the exception of Chapter 6 - the checklist, no changes may be made to the wording of the Protocol including any Standards, Guidelines, commentary, tables or diagrams. Excerpts from the Protocol may be used in support of the checklist. References and acknowledgments must be maintained in any reproduction or copy in full or part of the Protocol. 4. In regard to Chapter 6 of the Protocol - the checklist: o The wording of the Standards may not be altered in any way and must be included as part of the checklist. o Guidelines are optional and those which are deemed not applicable may be removed. o Numbering of Standards and Guidelines must be retained in the checklist, but can be reduced in size, moved to the end of the checklist item or greyed out or other means to minimise the visual impact. o Additional items for local use may be added but must not be numbered as a Standard or Guideline, in order to avoid confusion with the RCPA checklist items.
    [Show full text]
  • Bone Marrow Test
    Bone Marrow Test Bone marrow biopsy and bone marrow aspiration are procedures performed to diagnose and monitor blood and marrow diseases, often to find out if cancer or infection has spread to the bone marrow. A bone marrow biopsy removes a small amount of bone, fluid, and cells from inside the bone (bone marrow), while a bone marrow aspiration removes only the marrow. What are Bone Marrow Biopsy and Bone Marrow Aspiration? Bone marrow biopsy and bone marrow aspiration are procedures performed to diagnose and monitor blood and marrow diseases, often to find out if cancer or infection has spread to the bone marrow. A bone marrow biopsy removes a small amount of bone, fluid, and cells from inside the bone (bone marrow), while a bone marrow aspiration removes only the marrow. Bone marrow biopsy and aspiration refer to the diagnostic procedures performed to collect a sample of the bone marrow. The bone marrow is a soft, spongy tissue present in some larger bones of the body. Bone marrow biopsy and aspiration are recommended for the detection of the abnormalities related to the bone marrow. This test can help to assess whether the bone marrow is healthy and produces the normal amount of different blood cells. These tests are also advised for monitoring blood and bone marrow diseases such as cancers and a fever of unknown origin. The bone marrow consists of two different portions of which one is fluid in consistency and the other is solid. During bone marrow biopsy, the doctor inserts a needle into the bone to withdraw a small sample of the solid portion.
    [Show full text]
  • Significance of Bone Marrow Histology in the Diagnosis of Acute Myeloid Leukemia
    Significance of Bone Marrow Histology in the Diagnosis of Acute Myeloid Leukemia Usman Younus,1 Kanwal Saba,2 Javeria Aijaz,3 Mulazim Hussain Bukhari,4 Samina Naeem5 Abstract cific esterase, Chloracetate Esterase and Acid Phos- phatase, and SBB. Bone marrow biopsy specimens Background: Acute Myeloid Leukemia (AML) is a were obtained from post superior iliac crest with a heterogeneous disease. The precise diagnosis requires manual trephine and were processed in plastic after a careful morphological examination of a well pre- decalcification. pared bone marrow aspirate along with flow cytometry Results: In all the cases there were better diagnostic and genetic analysis wherever required. Traditionally, clues through histological examination of bone mar- bone marrow biopsy has not been considered an essen- row particularly in assessing the cellularity, degree of tial diagnostic modality for AML. The aim of this stu- fibrosis, extent of blast infiltration, percentage of infla- dy was to assess the diagnostic as well as prognostic mmatory cells, dysplastic changes and residual haema- significance of bone marrow histology in patient with topoiesis. All these features were better noted in histo- acute myeloid leukemia. logical examination of core biopsy. Materials and Methods: Forty (40) patients of AML Conclusion: The histological examination provided underwent a bone marrow examination including an information additional to that provided by aspirate aspirate and a trephine biopsy. Air dried films of peri- smears about the bone marrow changes in AML and pheral blood and aspirates were fixed in methanol and suggested that some of the features may also have pro- stained with Giemsa. The following cytochemical stai- gnostic significance in addition to diagnostic impor- ns were also applied: PAS, Myeloperoxidase, Non spe- tance.
    [Show full text]
  • Bone Marrow Biopsy Evaluation in Cases of Pancytopenia-An
    isord D ers OPEN ACCESS Freely available online od & lo T r B f a n o s l f a u Journal of n s r i o u n o J ISSN: 2155-9864 Blood Disorders & Transfusion Research Article Bone Marrow Biopsy Evaluation in Cases of Pancytopenia-An Institutional Experience Pranati Mohanty1*, Ratiranjan Swain1, Sandhya Rani Sahoo1, Sudha Sethy2 1Department of Pathology, SCB Medical College, Cuttack, Odisha, India; 2Department of Clinical Hematology, SCB Medical College, Cuttack, Odisha, India ABSTRACT Background: Pancytopenia is not a disease entity, but a triad of findings, resulting from various disease processes. It is characterized by anaemia, leucopenia and thrombocytopenia in the peripheral blood. Bone marrow examination is of utmost importance in evaluation of pancytopenia and thereby identification of disease process is helpful for appropriate management. Aims and Objectives: To analyse wide spectrum of haematological diseases giving rise to pancytopenia in bone marrow trephine biopsy. Materials and Methods: This was a prospective study conducted in the department of Pathology and Clinical Hematology, S.C.B. Medical College, Cuttack for a period of 2 years including 122 pancytopenia patients. Complete blood count including peripheral smear examination, followed by bone marrow aspiration (BMA) and trephine biopsy were carried out in all cases. Informations were compiled and analysed. Results: Among 122 patients studied, 63.1% were males and 36.9% females. Aplastic anaemia was the commonest cause of pancytopenia (51%) followed by megaloblastic anaemia (23%). Other causes include acute leukaemia 9%, MDS 6%, primary myelofibrosis 2%, lymphomatous infiltration in the marrow 2%, and multiple myeloma 3%. Metastatic deposit, tuberculosis, haemophagocytic syndrome and hypersplenism constituted 1% each.
    [Show full text]
  • Bone Marrow Morphology in Multiple Myeloma
    BONE MARROW MORPHOLOGY IN MULTIPLE MYELOMA DISSERTATION SUBMITTED FOR M.D.IN PATHOLOGY THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY DEPARTMENT OF PATHOLOGY PSG INSTITUTE OF MEDICAL SCIENCE AND RESEARCH PEELAMEDU, COIMBATORE – 641 004 TAMILNADU, INDIA. APRIL 2012 Certificate CERTIFICATE This is to certify that the dissertation work entitled “ BONE MARROW MORPHOLOGY IN MULTIPLE MYELOMA” submitted by Dr. Yegumuthu. K is the work done by her during the period of study in the department of Pathology, PSGIMS & R from June 2009 to April 2012. This work was done under the guidance of Dr. Alamelu Jayaraman, Professor and Head, Department of Pathology, PSGIMS & R. Dr. Alamelu Jayaraman, Dr.S. Ramalingam, Professor & Head of the Department, Principal, Department of Pathology, PSGIMS & R, PSGIMS & R, Coimbatore-641 004 Coimbatore-641 004 Acknowledgment ACKNOWLEDGEMENT I wish to express my sincere gratitude to Dr.Alamelu Jayaraman , Professor & Head , Department of Pathology , PSG IMSR, for her invaluable guidance and constant support. I would also like to extend my humble thanks to all my Professors, Associate Professors and Assistant professors for their valuable suggestions and encouragement. I am extremely grateful to my husband Dr.M.Subbiah and family members who have been a source of strength in my research pursuit. My thanks and appreciations to all my colleagues who have helped me out with their abilities. I am very thankful to our senior technicians Mrs.Angeline Mary, Mr.Mani and other staff for their skillful technical assistance. I am obliged to all patients who contributed to my study and findings. Lastly I offer my regards to all those who supported me in any respect during the completion of the project.
    [Show full text]
  • Patient Information Sheet Specialist - Bone Marrow Examination
    Patient Information Sheet Specialist - Bone Marrow Examination An appointment is necessary for this test Your doctor has referred you to have a bone marrow “aspiration” or “trephine” performed by a specialist pathologist at Capital Pathology. Description Your bone marrow is responsible for the production of blood cells. These cells include red cells, white cells and platelets. It is also involved in the production of lymphocytes. In adults, active bone marrow is present in a number of sites, the most easily accessible of which is the pelvic bone in your lower back. Procedure Your bone marrow collection involves two procedures, which are both performed at the same site. You are positioned on your side and local anaesthetic is infiltrated into the area from which the biopsy will be taken. When the anaesthetic has taken effect, a small needle is introduced into the bone and some liquid marrow is withdrawn. The second procedure takes a little longer and involves biopsy of the bone itself through a second needle. You will experience a feeling of pressure in the area, and there may be some pain and discomfort associated with the procedure. When the procedure is completed, a dressing is applied and we will ask you to remain resting for five or ten minutes. We suggest that you be accompanied home by a friend or relative if possible Complications are rare. Local bruising occurs occasionally. Other reported complications include local haemorrhage and infection. After the procedure you may experience some discomfort as the local anaesthetic wears off. This can be adequately treated at home with one or two paracetamol (e.g.
    [Show full text]
  • ICSH Guidelines for the Standardization of Bone Marrow Specimens and Reports
    REVIEW ARTICLE INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY ICSH guidelines for the standardization of bone marrow specimens and reports † ‡ § – S.-H. LEE*, W. N. ERBER ,A.PORWIT,M.TOMONAGA,L.C.PETERSON FOR THE INTERNATIONAL COUNCIL FOR STANDARDIZATION IN HEMATOLOGY *Department of Haematology, SUMMARY St George Hospital, Sydney, NSW, Australia The bone marrow examination is an essential investigation for the † Department of Haematology, diagnosis and management of many disorders of the blood and bone Addenbrooke’s Hospital, Cambridge, UK marrow. The aspirate and trephine biopsy specimens are complemen- ‡Department of Pathology, tary and when both are obtained, they provide a comprehensive Radiumhemmet, Karolinska evaluation of the bone marrow. The final interpretation requires the University Hospital, Stockholm, integration of peripheral blood, bone marrow aspirate and trephine Sweden §Department of Hematology, biopsy findings, together with the results of supplementary tests such Nagasaki University Hospital, as immunophenotyping, cytogenetic analysis and molecular genetic Nagasaki City, Japan studies as appropriate, in the context of clinical and other diagnostic – Department of Pathology, findings. Methods for the preparation, processing and reporting of bone Feinberg Medical School of Northwestern University, Chicago, marrow aspirates and trephine biopsy specimens can vary considerably. IL, USA These differences may result in inconsistencies in disease diagnosis or classification that may affect treatment and clinical outcomes. In Correspondence: Szu-Hee Lee, Department of Hae- recognition of the need for standardization in this area, an interna- matology, St George Hospital, Kog- tional Working Party for the Standardization of Bone Marrow arah, Sydney NSW 2217, Australia. Specimens and Reports was formed by the International Council for Tel.: +61 2 91133426; Standardization in Hematology (ICSH) to prepare a set of guidelines Fax: +61 2 91133942; E-mail: szu-hee.lee@sesiahs.
    [Show full text]
  • Acute Lymphoblastic Leukemia
    The ALL Guide Information for Patients and Caregivers Acute Lymphoblastic Leukemia Estephana, ALL survivor This publication was sponsored by Revised 2014 A Message From Louis J. DeGennaro, Ph.D. Interim President and CEO of The Leukemia & Lymphoma Society The Leukemia & Lymphoma Society (LLS) wants to bring you the most up-to-date blood cancer information. We know how important it is for you to understand your treatment and support options. With this knowledge, you can work with members of your healthcare team to move forward with the hope of remission and recovery. Our vision is that one day most people who have been diagnosed with acute lymphoblastic leukemia (ALL) will be cured or they will be able to manage their disease with good quality of life. We hope that the information in this Guide will help you along your journey. LLS is the world’s largest voluntary health organization dedicated to funding blood cancer research, advocacy and patient services. Since its first funding in 1954, LLS has invested almost $1 billion in research specifically targeting blood cancers. We will continue to invest in research for cures and in programs and services that improve the quality of life of people who have ALL and their families. We wish you well. Louis J. DeGennaro, Ph.D. Interim President and CEO Inside This Guide 2 Introduction 3 Here to Help 7 Part 1—Understanding ALL About Marrow, Blood and Blood Cells About ALL Diagnosis 12 Part 2—Treatment Choosing a Specialist Ask Your Doctor Treatment Planning About ALL Treatments Central Nervous System (CNS) Leukemia Postremission Therapy Ph-Positive ALL Relapsed and Refractory ALL Stem Cell Transplantation ALL Treatment in Young Adults ALL Treatment in Adults 25 Part 3—About Clinical Trials 26 Part 4—Side Effects and Follow-Up Care Side Effects of ALL Treatment Long-Term and Late Effects Follow-Up Care Tracking Your ALL Tests 31 Take Care of Yourself 32 Medical Terms This LLS Guide about ALL is for information only.
    [Show full text]