aspirate


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  • Erythroid

    • tend to cluster in erythroid islands, characteristic clumpy chromatin
    • proerythroblast (12-20 um): large, bluer than myeloblasts, fine chromatin
    • early erythroblast (basophilic erythroblast): blast-like, but smaller, chromatin starts to clump
    • intermediate erythroblast (polychromatic erythroblast): characteristic clumpy chromatin
    • late erythroblast (orthochromatic erythroblast): small cell, pinker cytoplasm

  • Granulocytic

    • myeloblast (12-20 um): high NC ratio, large and blue, nucleoli, nuclear membrane more irregular than erythroblasts
    • promyelocyte (15-25 um): more cytoplasm (larger, lower NC ratio), blue, prominent purple granules, paranuclear Golgi (eccentric nucleus), single nucleolus
    • myelocyte (10-20 um): pinker cytoplasm (finer granules), lack nucleolus
    • metamyelocyte (10-12 um): U shaped or indented nucleus
    • band: band shaped nucleus
    • neutrophil: segmented nucleus

  • Megakaryocytic

    • immature: smaller, high NC ratio, blue, blebbed cytoplasm
    • mature: up to 160 um, lobulated nucleus, pink cytoplasm
    • late: smaller, shed cytoplasm (super high NC ratio), pyknotic nucleus
    • stains: CD61, CD41

  • Hematogones

    • immature lymphocytes
    • can be alot in young pt
    • looks like leukemic blasts, but there's a spectrum of maturation (CD20)

  • Other cells

    • lymphocytes
    • plasma cell
    • monocyte
    • macrophage: can be in erythroid clusters
    • mast cells/basophils: packed with purple granules
    • osteoclast: multinucleated, granulated cytoplasm
    • osteoblast: looks like plasma cells but larger, more cytoplasm, Golgi does not abut nucleus
    • capillaries: parallel spindle cells
    • endothelial cells, epithelial cells

  • Strong dysplasia (rarely normal)

    • nuclear bridging in erythroid
    • ring sideroblast
    • agranular neuts, Pelger Huet
    • micromegas (< 30 um) in young pt

  • Weak dysplasia (can be normal, esp in elderly)

    • erythroid
      • binuclearity
      • cytoplasmic bridging
      • detached nuclear fragments
      • irregular hemoglobinization
      • scattered hemosiderin granules
    • dyserythropoiesis
    • non lobated or multinucleated megas

  • Other

    • can use blood for flow if dry marrow aspirate: CLL, splenic MZL, LPL
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