骨髓细胞形态学

Neutrophilic Myelocyte 中性中幼粒细胞
S: 10-20 μm, round , reduction in N:C
N: oval or slightly distorted, usually eccentric, chromatin pattern becomes coarser, purple in color, without nucleoli
Neutrophilic Stab granulocyte 中性杆状核粒细胞
S: 10 to 15 μm, round N: band shaped, U-shaped, S-shaped,
coarse chromatin, distinct vice-chromatin C: same as the metamyelocyte
Early normoblast 早幼红细胞
S: 10-18 μm, round or oval N: round, central chromatin pattern slightly condensed nucleoli are present, but not always visible
C: moderate in amount, intensely blue and opaque, perinuclear pale zone is visible
Myeloblast 原粒细胞
S: size and shape N: nucleus C: cytoplasm
S: 10-20 μm in diameter, round or oval
N: round or oval, central or eccentric, fine chromatin in reddish-purple, 2-5 obvious nucleoli
Polychromatic normoblast 中幼红细胞
S: 8-15 μm, round
N: smaller, round, central, chromatin pattern more condensed in deep purple with distinct vice-chromatin , nucleoli absent
0-1 0.04-2.5 3.2-13.2 5.2-20.2 8.5-24.4 6.1-24.9 0-1.1 0-2 0-1.1 0-3.4 0-0.1 0-0.1 0-0.1 0-0.3 0-0.5 0-2 3.8-13 3.4-10 0-0.6 8.4-32.4 0-2.9 0-1.2
骨髓涂片
naked megakaryocyte （裸核型巨核细胞） platelet （血小板）
Megakaryoblast 原始巨核细胞
S: 15-30 μm, round or irregular N: large, round or irregular. coarse reticular and
condensed chromatin in purple, 2-3 vague nucleoli C: small to moderate cytoplasm in deep blue, may
细胞大小 核大小 核质比例 核形态 核染色质 核膜 核仁 胞质量 胞质颜色 胞质颗粒
原始→→成熟
大→小
大→小
大→小
圆→凹陷→分叶 （规则→不规则） 细致→粗糙 疏松→致密 不明显→明显
有→无
少→多
蓝（嗜碱）→红（嗜酸） 或天蓝→浅蓝 无→少→多
备注
原始粒细胞比早幼粒细胞小， 巨核细胞由小变大 成熟红细胞核消失
骨髓细胞形态学检查
骨髓的造血分化
Stem cells
外周血或淋巴系统
骨髓穿刺
涂片细胞学
活检组织学
粒系：红系=1-5.2:1
原始粒细胞 早幼粒细胞 中性中幼粒细胞 中性晚幼粒细胞 中性杆状核粒细胞 中性分叶核粒细胞 嗜酸性中幼粒细胞 嗜酸性晚幼粒细胞 嗜酸性杆状核粒细胞 嗜酸性分叶核粒细胞 嗜碱性中幼粒细胞 嗜碱性晚幼粒细胞 嗜碱性杆状核粒细胞 嗜碱性分叶核粒细胞 原始红细胞 早幼红细胞 中幼红细胞 晚幼红细胞 幼稚淋巴细胞 淋巴细胞 单核细胞 浆细胞
有的细胞不分叶
淋巴细胞核膜较明显
小淋巴细胞胞质较少
小淋巴细胞无颗粒
骨髓中各系比例和形态
粒系 红系 巨核 淋巴系 单核系 浆细胞系
粒系各阶段组成
Myeloid（粒系）
Myeloblast (原始粒细胞) Promyelocyte (早幼粒细胞) Mylocyte (中幼粒细胞) Metamylocyte (晚幼粒细胞) Band (杆状核细胞) Neutrophil (分叶核粒细胞)
C: more amount cytoplasm in deep blue, reddishpurple granules visible, pseudopod visible
增生判断：
有核细胞：红细胞1:1˜5增生极度活跃；1:10增生明显活 跃；1:20 增生活跃；1:20 ˜ 50增生尚可；1：50增生低 下；1:200增生极度低下。
取材稀释判断：取材稀释为～取材时混入外周血，导
致骨髓成份减少或缺如，无法代表骨髓。 1、外观无或少骨髓小粒 2、骨髓分类成熟粒细胞为主或淋巴细胞为主，骨髓有核 细胞少（幼粒幼红及巨核细胞少） 3、骨髓非造血细胞少：包括浆细胞，成纤维细胞，吞噬 细胞，组织嗜碱性粒细胞等
C: abundant in quantity, polychromatic (grey-blue to pink-grey)
Orthochromatic normoblast 晚幼红细胞
S: 7-10 μm, round
N: round, central or eccentric, pyknotic chromatin pattern in black purple, vice-chromatin may visible or invisible, sometimes extrusion
Pronormoblast 原始红细胞
S: 15-25 μm，round with pseudopod（伪足）
N: round, central, granulous chromatin stained reddishpurple, 1-3 bluish nucleoli
C: moderate in amount , deep blue in color and opaque, showing tumor like protrusion and a distinct perinuclear pale zone, no granules
Neutrophilic Segmented Granulocyte 中性分叶核粒细胞
S: 10 to 14 μm, round
N: usually 2 to 5 lobes, connected by filaments strand of heterochromatin, coarse clumped chromatin pattern.
C: moderate or abundant in amount, pale blue to deep blue in color, contains a few or many azurophilic granules which are variable in size and shape, often over nucleus
巨核系
巨大细胞 低倍镜观察 7-35枚/涂片 产生血小板
Normal megakaryocyte
正常人16N巨核细胞占50%-55%，8N及 32N占10-30%，2N，4N，64N，128N极少。
Megakaryocyte series
Megakaryocytopoiesis development occurs by endomitosr horseshoe shaped , eccentric, with coarser
chromatin pattern, vice-chromatin（副染色质）appears C: abundant, reddish, full of pink neutrophilic granules
C: abundant in quantity, pinker than previous stage
Erythrocyte 红细胞
6-8 μm in diameter, 7.2 μm on average, a small area of central pallor, anuclear, pink, biconcave disk
stages of megakaryocytic maturation: megakaryoblast （原始巨核细胞） promegakaryocyte （幼稚巨核细胞） granular megakaryocyte （颗粒型巨核细胞）
thrombocytopoietic megakaryocyte(产血小板型巨核细胞)
have pseudopod, no granules
Promegakaryocyte 幼稚巨核细胞
S: 30-50 μm, irregular
N: irregular in shape, may show slight lobulation, multi-nuclei, coarser chromatin, nucleoli indistinct
C: abundant, reddish or light blue, pink specific secondary granules may be seen as pinkish areas near the nucleus first (barely visible)