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Blood Hematopoietic Disease :Examination of peripheral blood and bone marrow in blood diseases

• Visual contact is important in the examination of peripheral blood.

In CBC test (RBC, Hb, Ht, WBC, Blood platelet count), not only hematology but also pulling peripheral blood smear and reading smear by visual contact are important.

Abnormality of Neutrophil configuration
In bone marrow dysplasia syndrome (MDS), neutrophil indicating false Pergel nuclear anomaly as Low-leaf nuclear anomaly can be seen. And in Vitamin B12 deficiency Big PRCA anemia, hyper-segmented neutrophil can be seen. In WHIM (Warts, hypo-gammaglobulinemia, infections, and myelokathexis syndrome) syndrome, overgrowth neutrophil (aspect is condensed nuclear and vacuole cytoplasmic morphology connected by long and arced fiber) is seen. In May-Hegglin disease, one of MYH9 abnormal disease, inclusion body in the neutrophil reticulum can be seen. In Chediak-Higashi Syndrome (CHS), giant granule exist in cellular.
Blood Platelet Size
The volume of blood platelet is well analogized by smear observation, but as mentioned in thrombocytopenia section, the size of blood platelet should be paid more attention. There are with reduced blood platelet number type and without reduced blood platelet type in the inherited thrombocytopenia. But especially in MYH9 Abnormal disease (May-Hegglin syndrome, Epstein syndrome), large platelet thrombocytopenia is characterized in which the size of blood platelet is larger than normal size. On the other hand, in Wiskott Aldrich syndrome (WAS), smaller platelet size is the characteristic in addition to the reduced blood platelet number.

• It is recommended to conduct Bone marrow test from iliac.

Bone-marrow examination is necessary for all blood diseases. Normally, bone puncture is performed, but in many cases, biopsy is requested. At this moment of time, it is recommended that the bone puncture (biopsy) should be performed from iliac bone side instead of breast bone. In Bone Puncture, it is important affair not only to have the observation of smear, but also flowcytometry examination for puncture fluid, chromosomal test, or to customary present for the clot sample preparation. Pathological examination of clot sample becomes the supplement to bone-marrow smear observation. When necessary, pathological tissue biopsy of clot sample can be used for EBER-ISH examination which investigate for immunostaining or EB virus infection disease. Information from smear observation is not so much, with utilizing one-time examination sample at most, definitive diagnosis is made with performing comprehensive evaluation for all this information. The same is applied to the biopsy of lymph node. (fig.3)

Fig.1 Rouleaux formation in over-viscosity syndrome

Fig. 2 Spherocytosis (A), Elliptocytosis (B), Stomatocytosis (C)

Fig.3 Examination procedure for Bone-marrow Examination, Lymph node Biopsy