![]() ![]() In the marrow of a normal individual, the proportion and types of cells present is very typical, and different diseases, including leukemia are reflected in too many of a particular type of cell, too few of a particular cell or cells, or abnormalities in the shape, size or structure of the cells present. Cells such as metamyelocytes, promyelocytes, normoblasts, and pronormoblasts are reported for example. There are many different types of cells that can be described in the differential that reflect the different maturation stages of the different types of normal cells that grow in the marrow. Normally, there are many different types of cells counted in the differential, including lymphocytes, many different forms of immature neutrophils and red blood cells and megakaryocytes, the cells that produce platelets and there are expected normal ranges in which these cells should be present. The differential provides the proportion of each type of cell in the marrow and typically the technician reviews 500 total cells to obtain the percentage of each. The aspirate is where the cell “differential” is obtained. This sample is usually taken first, and the liquid aspirate is smeared on microscope slides and stained so that the cells can be seen under a microscope. ![]() The marrow aspirate is obtained by placing a needle in the bone space and removing the “liquid” portion of the marrow. Unlike these organs, which can enlarge, the bone marrow cannot.īone marrow evaluation usually consists of collecting 2 different samples, the marrow aspirate and the bone marrow biopsy. CLL cells also reside in lymph nodes, liver, and spleen, which is why these organs enlarge with active and progressive CLL. The leukemia cells in CLL reside in the marrow space and this is where they multiply, which can result in “crowding out” of the normal stem cells and cause other blood cell counts, like red cells and platelets, to drop, since they are unable to grow. The boney structure that makes up the marrow space does not change, but the proportions and numbers of the different types of cells in the marrow do change, especially in patients with leukemia. It is only the “adult” forms of cells that normally circulate in blood. Normally, when stem cells mature they go through changes in their size, shape, and surface proteins, analogous to an individual maturing from an infant, toddler, child, teenager, etc., and ultimately they die of old-age. ![]() Blood vessels circulate blood with nutrients and oxygen in and out of the marrow. On the inside, bones are like a sponge, with hollow spaces where these cells reside. There are many different types of cells in the marrow, including fat cells. The cells that make blood cells are referred to as stem cells. The bone marrow is an organ that resides inside bones, and is where the cells that circulate in the blood are formed. In untreated patients with CLL, the bone marrow virtually always has leukemia cells present, including at initial diagnosis. The following provides the very basics of bone marrow evaluation for patients with CLL and SLL. It is common for patients to call me after having reviewed their bone marrow report and ask for my interpretation in wording they are able to understand. Finally, the reports typically use medical words that patients are unfamiliar with. This is because there is variability in the testing done for the evaluation and there is variability in how laboratories and pathologists report the information. Reviewing and understanding your bone marrow report can be confusing and difficult.
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