Download - Bone Marrow Aspiration in Hematooncology
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Dr. P.G.SubramanianAssistan Professor and Officer incharge Hematopathology
laboratoryTata Memorial Hospital
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Diagnostic◦ Thrombocytopenia◦ Bicytopenia◦ Pancytopenia◦ Unexplained organomegaly/ Fever/anemia◦ Suspected acute leukemia
Staging for lymphomas Baseline evaluation –◦ Chronic myeloproliferative disorders◦ Myeloproliferative myelodysplastic disorders◦ Plasma cell dyscrasias
Post treatment evaluation◦ Post induction, Day 10 marrows◦ Clinical suspicion of relapse Unexplained cytopenias Unexplained fever
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Cytochemistry –◦ Perls iron stain◦ Myeloperoxidase◦ Sudan black B◦ Non specific esterases – ( α-naphthyl acetate or α-
naphthyl butyrate esterase)
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Immunophenotyping by flow cytometry Cytogenetics Molecular testing Culture
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Normal bone marrow
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Megakarocyte
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Increased blasts greater than 20%. Acute leukemia/ CML blast crisis (presence of
a documented chronic phase)/ rarely high grade non hodgkins lymphoma
Various morphology of blasts Cytochemistry/ Immunophenotyping
/Cytogenetics/ molecular studies
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Myeloperoxidase- If positive Acute Myeloid Leukemia. If negative then immunophenotyping is essential.
Nonspecific esterase – positive in Acute Monoblastic and Acute Monocytic leukemias
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Essential for diagnosis of ◦ Acute Lymphoblastic Leukemia (B cell and T cell
type)◦ Acute Myeloid Leukemia M0◦ Acute Monoblastic Leukemia M5◦ Acute Megakaryoblastic Leukemia M7
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2 techniques Immunohistochemistry Flow cytometry using
immunofluorescence
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Comparison of the two methods currently
Flow cytometry(Immunofluorescence)
Immunohistochemistry
Multiparametric evaluation of single cells
Higher sensitivity
Requires significant concentration of population of interest in the sample
Gives accurate counts and percentages
Fixation and antigen retrieval problems
Morphological confirmation of population of interest
Can detect a few cells in a section
Certain degree of subjectivity in interpretation of weak positivity
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Essential for diagnosis of ◦ Philedelphia chromosome positive leukemias and
CML blast crisis◦ Acute promyelocytic leukemia ◦ AML
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AML-M3
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Case: APML
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24/06/2010
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8 yr male child referred from outside as case of Acute Lymphoblastic Leukemia.
ThrombocytopeniaBone marrow done – dilute with scattered 40% blasts
like cells and 60% lymphocytesMPO - Negative
FCM - Outside diagnosed as CALLA positive ALL with CD19+, CD10+, HLADR+ & small percentage
of CD34+ cells
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R1
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Hematogones
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Hematogones
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Another case : new case4 yrs female child,
High WBC count, thrombocytopenia and low HbBM – 90% blasts, MPO – negative
Immunophenotyping done
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R1
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HEMATOGONES CALLA+ ALL BLASTS
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12 yr old boy with hepatosplenomegaly and lymphadenopathy with complaints of weakness and difficulty in breathing.
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Morphology
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Diagnosis:T- cell Acute Lymphoblastic Leukemia
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5 year old Male child Presented with weakness and severe Pallor. Hb – 4 gm / dL
Given one unit of blood at the local clinicCBC showed few blasts and referred.
Bone marrow on examination shows 45% blasts mixed with lymphocytes and normal myeloid series cells
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Diagnosis????
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Dyserythropoiesis MDS
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43 Yr Male
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Hairy Cell Leukemia
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HCL
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Reed Stern berg Cell
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