Hemepath bone marrow question

[Giemsa]

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When counting a bone marrow aspirate, do you put myeloblasts (as in AML) into the myeloid fraction of the myeloid to erythroid ratio, or leave them out because they're not really part of the "normal" population?

Just curious what you do.

 

[mlw03]

Shoot... I'm trying to remember what we did at my residency program. I want to say we counted them, recognizing it would give fairly useless ratios in the setting of an acute leukemia, but I'm not sure so I shall refrain from voting. My hemepath is now limited to looking at lymph nodes and bone marrow section of infants and saying that I don't see leukemia, and if I ever even remotely thought I did, first thing I'd do is find a peds or heme pathologist to help me sort it out.

 

[pathstudent]

What kind of question is this? How are they not normal? Do you count dysplastic neutrophils as part of the myeloids even though they wouldn't be normal? Of course you do. You are the first person I have ever heard ask this.

 

[coroner]

By definition, M:E ratio is the TOTAL bone marrow granulocytes and precursors (including all types of myeloid blasts) in proportion to the total erythrocytes & precursors. But in case you get a few tongue-in-cheek responses, it's because generally people aren't eager to help with questions that can easily be looked up in a book...they'd rather bitch about the job market 😉

 

[univlad]

I would put them in the myleoid fraction as they are myeloid precursors, though I don't think I calcultate or report the M:E ratio for most AML cases.

 

[Gene_]

Of course myeloblasts should be included as myeloids.

I generally report the M:E ratio when it emphasizes an abnormality in the differential that I want to highlight. Another time it may be useful to report M:E routinely is when you are reporting an overly complex differential such as breaking down erythroid precursors (proerythroblasts, basophilic normoblasts, etc) and granulocytic precursors (pro, myelo, meta, etc.) so that the M:E math can't be done easily by the oncologist.

 

[Giemsa]

But in case you get a few tongue-in-cheek responses, it's because generally people aren't eager to help with questions that can easily be looked up in a book...they'd rather bitch about the job market 😉

*Sigh*

I thought it might be nice to see clinical questions / interesting cases presented here.

I couldn't think of a better question (we don't report the M:E as such). Maybe I should have gone with something about smudge cells.

 

[yaah]

I don't unless it matters for the case, but it usually doesn't matter because it doesn't impact it to a substantial extent. Ratio is most useful when blasts are not that increased. I just report the percentage of everything in case they care.