L11 BONE MARROW

Question 1

define aplasia

Answer 1

lack of cell formation

Question 2

define hypoplasia

Answer 2

decreased cell formation

Question 3

define hyperplasia

Answer 3

increased cell formation

Question 4

define dysplasia

Answer 4

abnormal cell formation

Question 5

define dysmyelopoesis

Answer 5

abnormal haematopoesis

Question 6

define dyserythropoesis

Answer 6

abnormal eryhrocyte prod

Question 7

define dtysgranulopooesis

Answer 7

abnormal granulate production

Question 8

define myelophthisis

Answer 8

displacement of haematopoietic tissue by other tissue ie/ fibrosis, inflammatory cells or neoplasia

Question 9

define pancytopenia

Answer 9

concurrent anaemia, thrombocytopenia and leukopenia

everything decreased

Question 10

define aplastic anaemia

Answer 10

lack of formation of a cell line causing pancytopenia

Question 11

define pure red cell aplasia

Answer 11

lack of formation of erythroids only

Question 12

LIST some key disease off marrow

Answer 12

• myeloid leukaemia
• myelodysplasia
• myelofibroris
• myelophthisis
• myelonecrosis

Question 13

compare and contrast acute myeloid leukaemia with chronic myeloid leukaemia

Answer 13

ACUTE: 
- excessive blasts
- myeloid, erythroid or megakaryocytic origin
- hypercellular marrow 
agressive, poor prognosis 

CHRONIC

• excessive prod of mature cells of any cell line
• hypercell marrow w/ little blasts
• often w/ leukocytosis

Question 14

what is primary myelodysplasia (MDS), name some secondary causes

Answer 14

primary - neoplastic disorder causing abnormal cell production,
can also be secondary to toxins, drugs, viruses

Question 15

what is myelofibrosis

Answer 15

replacement of marrow by fibrous tissue
primary = neoplastic
secondary = IMHA

Question 16

what is myelonecrosis

Answer 16

necrosis of bone marrow, usually serous atrophy due to starvation.

Question 17

WHEN SHOULD YOU SUSPECT BONE MARROW DISEASE

Answer 17

PERSISTENT AND UNEXPLAINED

• CYTOPENIA
• CTYOSIS
• ABNORMAL CELL MORPHOLOGY
• HYPERGLOBULINAEMIA
• FEVER OF UNKNOWN ORIGIN
• HYPERCALCAEMIA
• LYTIC BONE DISEASE
• INFECTIOUS DX SCREENING - LESHIMANIASIS

Question 18

What are the three persistent cytopenia cell lines we should worry about? which ones should we not worry about and why

Answer 18

worry about persistent:
thrombocytopenia, neutropenia and non-regenerative anaemia
dont worry about basopenia, eosionopenia or monocytopenia because we see them so low in health

Question 19

what are some causes of persistent cytopenias

Answer 19

bone marrow neoplasia 
infectious dx - parvo, FIV, FeLV 
toxins - oestrogen (dogs), bracken fern (ruminants) chemotherapy 
IMHA 
endocrine - hypothyroidism, hypoadrenoc.

Question 20

what are the persistent cytosis that we should be worried about

Answer 20

• leukocytosis
• erythrocytosis
• thrombocytosis

Question 21

what are some bone marrow diseases resulting in leukocytosis, what must you rule out first?

Answer 21

need to rule out inflam or infection , paraneoplastic syndrome
could be :
- AML/ CML
- lymphoproliferative dx

Question 22

what are some bone marrow diseases resulting in erythrocytosis, what must you rule out first?

Answer 22

rule out dehydration, splenic contraction, hypoxia

causes: renal mass , polycythaemia vera

Question 23

what are some bone marrow diseases resulting in thrombocytosis, what must you rule out first?

Answer 23

rule out: inflammation, hypercortisolemia, splenic contraction, iron deficiency, paraneoplastic syndrome
could be:
- essential thrombocytopenia

Question 24

what kinds of abnormal cell morphology would suggest bone marrow dx?

Answer 24

• inappropriate release of immature cells
• disorderly left shit
• cytomegaly: giant neutrophil, macro platelets
• abnormal nuclear morph: abnormal segmentation of nucleus
• abnormal cytoplasm; inclusions, toxic change

Question 25

what are some causes of hyperglobulinaemia

Answer 25

inflammation: infection w/ leishmanaiais | lymphoid neoplasia: lymphoma, lymphoid leukamia, multiple myeloma, plasmocytoma

Question 26

what are the differentiates for hypercalcaemia

Answer 26

``` HARDIONS h - hyperparathyroidism a - addison (dogs) r - renal failure (horses) d - vitamin d toxicity i - idiopathic (cats) o - osteolysis n - neoplasia s - spurious ```

Question 27

what is multiple myeloma, what is the diagnostic criteria for it

Answer 27

plasma cell neoplasia must have two of the following to diagnose - neoplastic plasma cell in bone marrow - osteolytic lesions - monoclonal gammopathy (1 protein made) - light chain proteinuria

Question 28

what are the sites for bone marrow collection?

Answer 28

- pelvis; ileac crest - proximal femur - proximal humerus - sternum

Question 29

when would yo take a core biopsy?

Answer 29

- pancytopenia - RBR morph suggests myelofibrosis ie/ ovalocytes - no spicule evident in aspirate

Question 30

when would you NOT do bone marrow aspirate

Answer 30

coagulopathy - DIC - warfarin tox - hepatic dx * * caution w/ thrombocytopenia - might not be able to clot