Under normal circumstances, the whole development and evolution process of blood cells from primitive to mature stage has certain regularity: ① cell body size: with the development and maturity of blood cells, the cell body gradually changes from large to small (opposite to megakaryocytes), and the more mature the development, the larger the cell body. ②The nucleus of the mature red blood cells is from large to small, and the mature red blood cells have no nucleus;The shape of the nucleus varies from round to irregular, and the granulocyte is finally lobulated. The lymphocyte and plasma cell lines have little change;Chromatin changes from fine and loose to coarse and dense;The nuclear membrane is from inconspicuous to obvious;Nucleolus from presence to absence. ③The cell mass changes from less to more, and the lymphocytes do not change significantly. Rexhlet staining and Giemsa staining show that the cytoplasm changes from dark blue to light blue, and mature granulocytes and erythrocytes can change to pink and light red;Particles from none to presence. ④The ratio of nucleus to cytoplasm volume varies from large to small.Under pathological conditions, the above evolution law may be disordered.
Abnormal results: (1) Increased: it indicates bone marrow hyperplasia, such as leukemia, hemolytic anemia, hypersplenism, etc.(2) Decrease: It indicates that the function of hematopoietic tissue is decreased, such as aplastic anemia.People to be examined: children or adolescents with sudden fever, progressive anemia, significant bleeding tendency or bone and joint pain in the early stage of the disease;The elderly and some young patients with slow onset progressive fatigue, pale face, short of breath after fatigue, lack of appetite, weight loss or fever of unknown cause;People with anemia symptoms.
matters needing attention
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People not suitable for examination: hemophilia and disseminated intravascular coagulation. If there is no special need, bone marrow puncture is not allowed.Preoperative preparation: The patient should position himself according to the doctor's instructions.
Inspection process
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Examination method: bone marrow examination.Inspection process: (1) Select the puncture site.(2) Anesthesia.(3) Fix the length of puncture needle.(4) The left thumb and index finger of the doctor fix the puncture site, and the right hand holds the bone marrow puncture needle to penetrate vertically with the bone surface. If it is a sternal puncture, it should penetrate at an angle of 30o to 40o with the bone surface.When the needle tip of the puncture needle contacts the bone, rotate the puncture needle left and right along the long axis of the needle body of the puncture needle, and move forward to slowly penetrate the bone.(5) Extract the bone marrow fluid, pull out the core of the puncture needle, connect a dry syringe (10m1 or 201m1), and extract the bone marrow fluid with appropriate force.(6) Smear: It is required that the smear glass and slide should be clean and free of putty pollution. The smear should be thin and even, with about 10 smears. At the same time, two blood slides should be made for comparison.(7) Dyeing: Rayleigh Giemsa mixed dyeing method is commonly used;Cytochemical staining is often used together.(8) Microscopic observation.
