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| Bone
Marrow Findings |
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[concerning
adequacy]
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Implicitly desired information when BM done
in:
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a new acute leukemic case, initial diagnostic
marrow:
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correct diagnosis
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percentage cellularity, and
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percentage blasts
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any indication of arising out of MDS
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a new acute leukemic, following induction
chemo:
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report & diagnosis to recap the leukemic
type
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report & diagnosis to state PB & BM
blast percentage
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note any presence or absence of chemo
effect
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opine as to any achievement of induction
of remission [S-01-12630, acute monocytic
retaining 8% mod. diff. monocytics]
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note presence or absence of any apparent
M or E stimulant effect
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a new chronic leukemic case, initial diagnostic
marrow:
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a chronic leukemic case, follow-up marrow:
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CLL:
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CML: check previous studies and
see if evidence of acceleration (increasing blast count;
worsening anemia &/or thrombocytopenia)
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a (mono-, bi-, odd pan-)cytopenia of uncertain
etiology workup: is marrow hypercellular &, if so,
leukemia vs. MDS vs. MPS?
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a probable/possible myeloproliferative
syndrome workup: is marrow hypercellular (MPS always
is)? Is spleen enlarged (MPS almost always)? Is there
peripheral basophilic leukocytosis (MPS almost always)?
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a probable/possible myelodysplastic syndrome
workup: is there a PB cytopenia? Is marrow hypercellular
(MDS always is)? Is spleen enlarged (MDS not so)? Is
there peripheral basophilic leukocytosis (MDS not so)?
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a thrombocytopenia of uncertain etiology
workup: Is it failure to produce enough platelets
(decreased BM megs & all small PB platelets)? Or,
is it increased utilization of platelets (increased BM
megs & many intermediate sized PB platelets)? If
ITP, see little or no budding of platelets from meg edges & should
see meg hyperplasia (in marrow sections, two megs touching
is hyperplasia [S-04-12680]); if
due to "toxicity", look for meg vacuoles; if
due to MDS, look for meg dyspoiesis. If CBC smear has
easily found intermediate-sized platelets, then low count
is due to increased "utilization" of platelets.
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an anemia of uncertain etiology workup: Iron
deficiency? Chronic disease (iron uptake blockade...lots
of RES iron and few to no sideroblasts)? Occult myeloma?
Granulomata? Hypercellular (leukemia vs. MDS vs. MDS/MPS
overlap vs. MPS vs. hemolysis vs. met. ca.)?
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MGUS workup: plasma cells increased
(plasmacytosis of uncertain etiology vs. malignant cytology
of myeloma?
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lymphoma staging marrow: increased lymphoid
( small foci non-paratrabecular benign vs. paratrabecular
malignant)?
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Significance of some morphological findings:
- the M:E ratio:
- decreased:
- normal:
- increased:
- Neupogen therapy
- increased presence of mast cells:
- cytokine therapy, especially Interleukin-3 [S-01-4205]
- increased presence of megakaryocytes: (when megs
touch each other, there are too many)
- reactive
- "neoplastic"
- reticulin fibers encircle individual megakaryocytes
(as in MPS [LMC-01-2306])
- abnormal platelet aggregation studies
- abnormal cytogenetic studies
- abnormal trabeculae: keep eyes open for clinically
occult histo-morphologic evidence of osteoporosis, Paget's
disease, and metabolic disease causing excessive osteoblasts
and/or osteoclasts and evidence of trabecular remodeling
and/or foci of woven rather than lamellar bone [S-05-9777].
(posted 2002; latest addition 17
August 2005) |
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1999 - 2006, all rights reserved, Pathology Associates Of Lexington,
P.A. |
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