1、Bone Marrow: Non- Neoplastic Case Examples骨髓：非腫瘤例Clinical PathologyRose Raskin, DVM, PhD, DACVP, MRCVSPurdue University October 2018CYTO/HISTO CASE 細(xì)胞學(xué)/組織學(xué)病例0(PU 748-594)Canine, Pomeranian Female 9 years old 9歲 博美 母犬 Lethargy 嗜睡 Mammary mass 乳腺腫物 Treatment for seizures withphenobarbitol 2 years使用 治療

2、癲癇2年Test項(xiàng)目Result結(jié)果Flag標(biāo)志Ref.參考值Units單位TP-Plasma 血漿總蛋白7.36.0-8.0g/dlHematocrit比容21.4L37-55%Hemoglobin 血紅蛋白6.79L12-18g/dlRed Blood Cells 3.11L5.5-8.5x106/lMCV 平均體積68.860-75flMCHC 平均血紅蛋白濃度31.8L32-36g/dlWhite Blood Cells 白細(xì)胞0.93L6-17x103/lPlatelets 血小板66L200-900x103/lNRBC 有核24H/100 WBC細(xì)胞密集中度粒細(xì)胞系增生伴核左移明顯

3、系和巨核細(xì)胞系發(fā)育不全Hypercellular bone marrow Moderate granulocytic hyperplasia with left shift Marked erythroid and megakaryocytic hypoplasiaDx: Phenobarbital toxicity診斷：中毒 CBC became normal 2 mo after removal of drug and switch to a different anticonvulsant (Keppra) 停藥2月后CBC結(jié)果正常，更換另一種抗癲癇藥物（開浦蘭/左乙拉西坦） Canin

4、e, German Shepherd, 5 years old 5歲 德國牧羊犬 History of reluctance to jump 有不愿跳動(dòng)病史 Diagnosed with right lateralized Hansen type Idisk extrusion at L7-S1診斷為L7-S1右外側(cè)漢森型椎間盤脫出 Presented to PUVTH surgery service前往普渡大學(xué)獸醫(yī)教學(xué)醫(yī)院就診 Pre-operative CBC performed術(shù)前CBC檢查German Shepherd Dog德國牧羊犬項(xiàng)目檢測值參考范圍單位圧積血紅蛋白平均體積平均血紅

5、蛋白濃度血小板白細(xì)胞中性粒細(xì)胞桿狀中性粒細(xì)胞淋巴細(xì)胞單核細(xì)胞嗜酸性粒細(xì)胞Blood 血液Bone Marrow Aspirate 骨髓抽吸Bone Marrow Aspirate 骨髓抽吸 Inconclusive 不確定 Low intact cellularity細(xì)胞完整性低 Concern for myelofibrosis考慮骨髓纖維化Giemsa 吉姆薩染液CD11dReticulinIneffective erythropoiesis 無效系生成Megakaryocytic hyperplasia 巨核細(xì)胞增生Mild myelofibrosis 輕度骨髓纖維化Immune-med

6、iated disease免疫介導(dǎo)性疾病Follow Up 復(fù)查Date8/1/168/9/168/18/168/23/169/7/169/26/1610/13/16TP 總蛋白7.17.27.77.67.78.17.5RBC 1.81.982.92.334.14.75.01HCT圧積12.71421.318.933.936.536.2Hgb 血紅蛋白4.24.97.26.510.712.112.3MCV 平均體積70.470.673.481.282.677.672.2MCHC 平均血紅蛋白濃度33.134.733.834.331.733.134.1WBC 白細(xì)胞78.526.625.413.

7、41411.8Band neuts 桿狀中性粒細(xì)胞0.140.512.133.050.2700Seg neuts 葉狀中性粒細(xì)胞5.77.32019.311.511.99.9Lymphs 淋巴細(xì)胞0.70.41.310.40.60.4Mono 單核細(xì)胞0.210.262.662.031.211.541.53Eos 嗜酸性粒細(xì)胞0.210.260.530000Myelocytes 中幼粒細(xì)胞000.270000Metamyelocytes 晚幼粒細(xì)胞000.270000NRBC 有核0001101Reticulocytes 網(wǎng)織3.621.820.3102.5118.954.254.2Plate

8、lets 血小板248Clumped集群分布1197Clumped集群分布293247Treatment consisted of prednisone (1.7mg/kg SID)考慮用治療（1.7mg/kg 每日1次）CYTO/HISTO CASE #3(MSU C-521783/A-517905)Feline, Domestic Short Hair 8 years oldAnorexia & fever for two weeks 8歲 DSH近兩周厭食和發(fā)熱TestResultUnitsTP-Plasma 血漿總蛋白7.1g/dlHematocrit 比 容13.9%Hemoglob

9、in 血紅蛋白4.2g/dlRed Blood Cells 2.16x106/lMCV 平均體積64flMCHC 平均血紅蛋白濃度30.4g/dlWhite Blood Cells 白細(xì)胞3.1x103/lPlatelets 血小板32,500x103/lRetic 網(wǎng)織14,430/lFeline DSH 家養(yǎng)短毛貓Erythroid and granulocytichypoplasia Granular background和粒細(xì)胞系發(fā)育不全，顆粒背景Dx: Serous atrophy of fat診斷：漿液性脂肪萎縮Canine, Pembroke Welsh Corgi, 5 yea

10、rs old彭布羅克威爾士柯基，5歲 6 days of hematuria, melena, retrobubular hemorrhage, petechiae6天來血尿、黑糞、眼球后 ？、瘀點(diǎn) Previous diagnosis: Immune-mediated thrombocytopenia既往診斷：免疫介導(dǎo)性血小板減少癥 Treatment: dexamethasone, vincristine, multiple blood transfusions治療：地塞 、長春新堿、多次輸血 Test8/16BM-ASP8/20BM-core Ref. UnitsTP-Plasma 血漿

11、總蛋白5.5L3.6 L6.0-8.0g/dlHematocrit比容26L12.6 L37-55%Hemoglobin 血紅蛋白8.5L4.1L12-18g/dlRed Blood Cells 3.6L1.6L5.5-8.5x106/lMCV 平均體積72.576.7 H60-75flMCHC 平均血紅蛋白濃度32.832.532-36g/dlWhite Blood Cells 白細(xì)胞19.8 H48.9H6-17x103/lPlatelets 血小板1.0L1.53L200-900x103/lRetic 網(wǎng)織34,000268,96060,000/lASP：細(xì)針抽吸 CORE：空芯針活檢S

12、S-16Hypercellular marrow 細(xì)胞密集: Granulocytic hyperplasia with left shift 粒細(xì)胞系增生伴有核左移 Relative erythroid hypoplasia相對系發(fā)育不全 Severe megakaryocytic hypoplasia嚴(yán)重巨核細(xì)胞系發(fā)育不全 VWFBone Marrow Interpretation骨髓解讀 Granulocytic hyperplasia; moderate left shift with depletion of storage pools粒細(xì)胞系增生；中度核左移伴有儲(chǔ)存池消耗Infla

13、mmation 炎癥 Erythroid hyperplasia with dysplasia系增生伴有發(fā)育異常 Previous hemorrhage 之前有病史 Vincristine 長春新堿 Suspected megakaryocytic hypoplasia懷疑巨核細(xì)胞系發(fā)育不全 Immune-mediated thrombocytopenia免疫介導(dǎo)性血小板減少癥 VWF+ blast cell precursors VWF+原始細(xì)胞前體細(xì)胞Shetland Sheepdog, 7 yr, Female 7歲 喜樂蒂 母犬Presentation:Oral hemorrhage,

14、 conjunctival hemorrhage, and thoracic hematomas癥狀：口腔、結(jié)膜和胸部血腫比積PCV22.4%平均體積MCV67.9 fLNo polychromasia observed 未見多染性白細(xì)胞WBC800 /L分葉中性粒細(xì)胞Seg Neut300 /L淋巴細(xì)胞Lymphs500 /LReactive lymphocytes 反應(yīng)性淋巴細(xì)胞血小板Platelets0 /LDX: Erythroid/megakaryocytic aplasia; marked granulocytic hypoplasia consistent with estrog

15、en toxicity following treatment for urinary incontinence診斷：紅系/巨核細(xì)胞系發(fā)育不良；粒細(xì)胞系明顯發(fā)育不全，與尿失禁治療后雌激素中毒一致。MSU A-413018/C-513034 Feline, DSH 貓，家養(yǎng)短毛貓 1 years old, F 1歲，母貓 Respiratory difficulty; abscessedtonsil and severe necrotizing pharyngitis呼吸困難；扁桃體膿腫和嚴(yán)重壞死性咽炎 Anemia and neutropenia貧血和中性粒細(xì)胞減少癥Neutrophil Toxicity 中性粒細(xì)胞中毒ComponentFindingPCV(%)壓積 19LOcc poly, poik 2+WBC(/l) 白細(xì)胞8,522511 L 1,278 H 6Many 3+ toxic neut許多3+中性粒細(xì)胞毒性變化 Seg 分葉核中性粒細(xì)胞Band 桿狀核中性粒細(xì)胞Lymph 淋巴細(xì)胞 Mono 單核細(xì)胞 Eosin 嗜酸性粒細(xì)胞 NRBCs(/100