The bone marrow shown here is from the same patient whose blood smear was presented in slides 15 and 16. Notice the young granulocytes and the myeloid hyperplasia with a relative decrease in the number of NRBCs. This patient's bone marrow was overall hyperplastic with a normal number of megakaryocytes and a slight decrease in the number of NRBCs.
As you can see, from a bone marrow alone it is hard to tell leukemoid reaction from CML. The bone marrow in leukemoid reactions varies considerably depending on the underlying cause. The marrow may be hypoplastic or hyperplastic; the iron content and the number of NRBCs, young white blood cells, and megakaryocytes may be decreased, normal, or increased. If the M:E ratio is normal or decreased (normal, 4:1-2:1), the diagnosis is more likely leukemoid reaction. If the M:E ratio is increased, it is not helpful.
Course Section: 08. Myelocytic Leukemia: Chronic and Acute
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