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BONE MARROW

MORPHOLOGY
NORMAL AND ABNORMAL
FINDINGS
Bone marrow biopsy

H&E stain

Normal cellularity

Megakaryocyte Fat
Normal BM aspirate

Erythroid precursors

Myeloid precursors

M:E = 82:52 ( 2:1)


Normal BM aspirate ( M:E = 2:1 )
Normal BMA – Erythroid series

Blue cytoplasm
Grnaular chromatin

Condensed chromatin
Myeloid series
Normal BMA ( Myeloid series )
Pronormoblast
Myelocyte

Segmented
neutrophil

Band cell

Metamyelocyte

Promyelocyte
Myeloblast
Band cell
Normal myeloblast

Fine nuclear chromatin

Cytoplasm: deep blue


(lighter adjacent to
nucleus)

Nucleoli
Normal BMA (Plasma cell)

Plasma cell
10-20 u

Nucleus:: dark purple, ovoid,


eccentric, wheel-spoke pattern
Cytoplasm: deep blue with a
clear area next to nucleus
Myeloid precursors

Segmented neutrophil

Promyelocyte

Metamyelocytes
Myeloid precursors

Metamyelocytes

Band cell
Normal eosinophilic myelocyte
Basophilic myelocyte
Mast cell
Heavily basophilic
cytoplasm Cytoplasmic vacules

Nucleus : spared of
granules
BM macrophage

Nucleus: elongated,
spongy, purple

Engulfed debris
Megakaryocyte ( with engulfed RBC &
neutrophil )

Multilobular nucleus
Erythroid hyperplasia
Red cell aplasia
Hypoplastic marrow ( aspirate )
Aplastic anemia ( BM biopsy )

Very few stromal cells


No cellular elements
Red cell aplasia (arrest)
Parvovirus B19 infection
Giant pronormoblast

Cytoplasm: Deeply
basophilic, vacules
Megaloblastic anemia

Giant metamyelocytes

Open chromatin

Binucleated RBC precursors


Megaloblastic anemia

Polychromatophilic
megaloblasts with
nuclear cytoplasmic
development
dissociation
↑ Megakaryocytes ( ITP )
Iron stores in BM

Markedly increased Increased

Normal Absent
Toxic granulations
Chediak-Higashi Syndrome
Hemophagocytosis
ALL-L1

-Very fine chromatin


-Small lymphoblasts (up to
twice size of RBC)
-uniform in size
-Small cytoplasm
-Inconspicuous nucleoli
ALL-L1
ALL-L2
-Larger blasts
-More variation in size
-Different shapes of nuclei
-More obvious nucleoli
-More abundant cytoplasm
ALL-L2
ALL-L3

-Large heterogeneous blasts


-Irregular nuclei
-Prominent nucleoli
-Deeply basophilic cytoplasm
-Cytoplasmic vaculations
ALL-L3
AML-M1

-Uniform appearance
-Moderate rim of basophilic cytoplasm
-Single prominent nucleolus
AML-M2

Auer rod

-Abundant azurophilic
granules
-Some Auer rods
AML-M3 ( APL - Hypergranular)
Abnormal promyelocyte with
heavily azurophilic granulation

Faggot cell
(Auer rods)
AML-M3 (APL-microgranular variant)

Faggot
Microgranular promyeloblast cell
AML-M4 (Acute Myelomonocytic
Leukemia)
Myeloblasts

Monocytoblast
AML-M4 Eo ( Myelomonocytic leukemia
with eosinophilia ) [ inv 16]

Myeloblasts

Normal
eosinophils
Monocytoblast
AML-M5 ( Monocytic Leukemia )
AML-M6 ( Erythroleukemia )

Myeloblast with Auer rod

Erythroblasts
AML-M7 (Megakaryoblastic Leukemia)
Various sized blasts
Cytoplasm : abundant-rim around nucleus
Cytoplasmic blebs
Metastatic Neuroblastoma
( Rosette formation )
Reed-Sternberg cell (Hodgkin disease)
Binuclated nucleus
Prominent nucleoli
Cytoplasmic
vaculations
Gaucher cell
Cytoplasm: pale, filled with fibrillar lipid (wrinkled tissue paper appearance)
Nucleus: small, round, eccentric
Cystinosis Niemann-Pick
Disease
Nucleus: small,
round, eccenteric

Sphingomyelin
droplets
Leishmania donovani bodies
Osteoblasts
Cells found in clumps
Spindle-shape cells
Nucleus: single, oval, eccenteric
Nucleoli: 1-3 , light-blue
Osteoclast
Large cell with multiple nuclei(not connected)
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