Among the cells in the bone marrow reticular stromal cells differentiate and myelokaryocytes - hematopoietic tissue cells of the bone marrow (parenchyma) their derivatives - mature blood cells.

Reticular cells bone marrow stroma not directly involved in hematopoiesis, however, they are of great value, because it creates the necessary microenvironment for hematopoietic cells. These include endothelial cells, lining the bone marrow sinuses, fibroblasts, osteoblasts, fat cells. Morphology of them is no different from that described previously. In calculating the myelogram are regarded as reticular.

Smears of bone marrow first carefully scanned at low magnification to determine the quality of the preparation of smears and staining myelokaryocytes. At this magnification can detect complexes cancer cell metastasis of malignant tumors, Berezovsky-Sternberg cells, Pirogov-Langhans, accumulation of myeloma cells, Gaucher cells, etc.. Attention is drawn to the number of megakaryocytes. All cells in the bone marrow (no less 500) are counted in a row in several areas of stroke, and is determined by the percentage of each cell type (cm. table).

In assessing of bone marrow along with the percentage of it is taken into account the ratio of myelokaryocytes cells leykopo- Ethical number to the number of cells Erie- troblasticheskogo series. In healthy people, the ratio is leykoeritroidnoe 4:1 or 3:1. When hyperplasia elements erythrogenesis number of cells is increased by the erythro- kariotsitov and leykoeritroidnoe ratio drops to 1:1 less. This pattern is observed at various forms of anemia (posthemorrhagic, hemolytic, B₁₂-defi- -deficient).

With untreated B₁₂-deficiency anemia the number of cells increased mainly due megaloblasts, and at the beginning of remission - by normocytes. The value of the ratio reaches leykoeritroidnogo 1 :8. When complete remission is closer to the norm.

With a decrease in the number of items granulocytopoiesis decreases the value of the ratio leykoeritroidnogo. This pattern is observed in agranulocytosis.

While reducing the number of cells lejko- and erythrogenesis (t. it is. inhibiting both germ hematopoiesis) normal ratio therebetween can be maintained. This condition can be observed in aplastic anemia.

A significant increase in the number of bone marrow elements, along with the increase in the ratio leykoeritroidnogo indicative of myeloid hyperplasia elements. It is characteristic of leukemia, Infections, intoxication and other conditions.

In assessing of bone marrow It is also important to consider the relationship between the young and the more mature forms of neutrophils (medullary maturation index). Normally, it is 0,7. Determine medullary index ratio of:

(promyelocytes + myelocytes + metamyelocytes)/(stab + segmented neutrophilic granulocytes)

In the same way the index is determined by the maturation of eosinophilic granulocytes, normally it is also 0,7.

Index maturing erythrokaryocytes - A ratio of gemoglobinsoderzhashih normocytes (and in pathological cases - megaloblasts) to the number of all cells erythroblastic series:

(polychromatic + oxyphilic normocytes)/(erythroblasts + pronormotsity + normocytes (basophilic + polychromatic -+- oxyphilic)

Normally, this index is 0,8.

In assessing the myelogram is necessary to know the dynamics of peripheral blood and the patient's condition. In addition to changes in cell number leukopoiesis erythrogenesis and should take into account the degree of maturation.

By increasing the number of cells leuco- and erythrogenesis and a delay in the maturation of bone marrow may reduce their content in the peripheral blood. In other cases (eg, when eritremii) marked increase in the number erythrokaryocytes in the bone marrow without breaking the maturation, accompanied by an increase in the number of red blood cells.