Bone Marrow

Red marrow is found mainly in the flat bones such as hip bone, breast bone, skull,
ribs, vertebrae and shoulder blades, and in the cancellous ("spongy") material at the
proximal ends of the long bones femur and humerus.
www.sciencedaily.com
Bone marrow is the tissue comprising the center of large bones.
It is the place where new blood cells are produced.
Bone marrow contains two types of stem cells: hemopoietic (which can produce blood
cells) and stromal (which can produce fat, cartilage and bone).
There are two types of bone marrow: red marrow (also known as myeloid tissue) and
yellow marrow.
Red blood cells, platelets and most white blood cells arise in red marrow; some white
blood cells develop in yellow marrow.
The color of yellow marrow is due to the much higher number of fat cells.
Both types of bone marrow contain numerous blood vessels and capillaries.
At birth, all bone marrow is red.
With age, more and more of it is converted to the yellow type.
Adults have on average about 2.6kg (5.7lbs) of bone marrow, with about half of it
being red.
Red marrow is found mainly in the flat bones such as hip bone, breast bone, skull, ribs,
vertebrae and shoulder blades, and in the cancellous ("spongy") material at the
proximal ends of the long bones femur and humerus.
Pink Marrow is found in the hollow interior of the middle portion of long bones.
There are several serious diseases involving bone marrow.
In cases of severe blood loss, the body can convert yellow marrow back to red marrow
in order to increase blood cell production.
The normal bone marrow architecture can be displaced by malignancies or infections
such as tuberculosis, leading to a decrease in the production of blood cells and blood
platelets.
In addition, cancers of the hematologic progenitor cells in the bone marrow can arise;
these are the leukemias. [https://www.sciencedaily.com/terms/bone_marrow.htm]
emedicine.medscape.com

Over view
Bone marrow is the soft, spongy, gelatinous tissue found in the hollow spaces in the
interior of bones.[1] The average weight of this tissue is about 4% of the total body
weight, or 2.6 kg in an adult weighing 65 kg. Progenitor cell (stem cell) lines in the
bone marrow produce new blood cells and stromal cells. Bone marrow is also an
important part of the lymphatic system.
Bone marrow consists of stem cells, which are large, "primitive," undifferentiated cells
supported by fibrous tissue called stroma. There are 2 main types of stem cells and,

therefore, the bone marrow consists of 2 types of cellular tissue. One type of stem cell
is involved in producing blood cells and the other is involved in producing stromal
cells, which are responsible for the supporting stroma.

Types of Bone Marrow

Bone marrow can be 1 of 2 types, red or yellow, depending on whether it consists of
mainly hematopoietic (and therefore, red-colored) tissue or fatty (and therefore a
yellow-colored) tissue. Both types of bone marrow are highly vascular, being enriched
with numerous blood vessels and capillaries.
Bone marrow first appears in the clavicle near the end of fetal life and becomes active
about 3 weeks later. Bone marrow supersedes the liver as the major hematopoietic
organ at 32-36 weeks' gestation. At birth, all bone marrow is red. With age, more and
more of it is converted to the yellow type. In an adult, roughly half of the bone marrow
is still red.
Red marrow is found mainly in the flat bones, such as the hip bone, sternum (breast)
bone, skull, ribs, vertebrae, and shoulder blades, as well as in the metaphyseal and
epiphyseal ends of the long bones, such as the femur, tibia, and humerus, where the
bone is cancellous or spongy.
Yellow marrow is found in the hollow interior of the diaphyseal portion or the shaft of
long bones. By the time a person reaches old age, nearly all of the red marrow is
replaced by yellow marrow. However, the yellow marrow can revert to red if there is
increased demand for red blood cells, such as in instances of blood loss.
As needed, the stem cells differentiate to become a particular kind of cella white
blood cell, red blood cell, or platelet. Normally, only mature cells are released from the
marrow into the bloodstream.
Blood cell formation
All types of blood cells are derived from 1 common stem cell. Stem cells exist
throughout the life of an individual. The common stem cell produces 2 other stem
cells, the myeloid stem cell and the lymphoid stem cell. These stem cells divide to
eventually give rise to red blood cells, platelets, and most white blood cells in the red
marrow. (See the image Bonemarrow-13: Illustration of the pelvis to show the site of
bone marrow and blood cells derived from bone marrow.) Bone marrow thus contains
blood cells at varying stages of development.
Erythrocytes, granulocytes, monocytes, thrombocytes, and lymphocytes are all
formed in the bone marrow. T lymphocytes originate via lymphoid stem cells that

migrate to the thymus and differentiate under the influence of the thymic hormones
thymopoietin and thymosin.
The rate of blood cell production is controlled by the body's needs. Normal blood cells
last for a limited time. White blood cells last anywhere from a few hours to a few days,
platelets for about 10 days, and red blood cells for about 120 days. These cells must
be replaced constantly. Certain conditions may trigger additional production of blood
cells.
When the oxygen content of body tissues is low, if there is loss of blood or anemia, or
if the number of red blood cells decreases, the kidneys produce and release
erythropoietin, a hormone that stimulates the bone marrow to produce more red blood
cells. Similarly, the bone marrow produces and releases more white blood cells in
response to infections, and it produces and releases more platelets in response to
bleeding. If a person experiences serious blood loss, yellow bone marrow can be
activated and transformed into red bone marrow. As age progresses, more of the red
bone marrow turns into yellow bone marrow and the production of new blood cells
becomes more difficult.
[http://emedicine.medscape.com/article/1968326-overview]
www.medicalnewstoday.com

Bone Marrow - What Does Bone Marrow Do?

Written by Hannah Nichols Reviewed by Dr Helen Webberley
Knowledge center
Last updated: Fri 22 January 2016
Bone marrow is the spongy tissue inside some of the bones in the body,
including the hip and thigh bones. Bone marrow contains immature cells,
called stem cells.
Numerous people with blood cancers such as leukemia and lymphoma, sickle cell
anemia and other life-threatening diseases, rely on bone marrow or cord blood
transplants to survive.
Healthy bone marrow and blood cells are needed in order to live. When disease affects
bone marrow so that it can no longer function effectively, a marrow or cord blood
transplant could be the best treatment option; for some patients it is the only
potential cure.
Fast facts on bone marrow
Here are some key points about bone marrow. More detail and supporting information is in the main article.

A bone marrow transplant can save the lives of people battling leukemia, lymphoma and other blood cancers.
At birth, all bone marrow is red. As humans age, red marrow increasingly begins to convert to yellow marrow.
In adults, around half of the bone marrow is red and half is yellow.

200 billion new red blood cells are made by the bone marrow every day, along with white blood cells and
platelets.
Around 1% of the body's red blood cells are regenerated every day.
Healthy bone marrow manufactures between 150,000 and 450,000 platelets per microliter of blood, the
amount of blood that fits on the head of a pin.
Bone marrow contains mesenchymal and hematopoietic stem cells.
Around 10,000 people in the US are diagnosed each year with diseases that require bone marrow transplants.
7 out of 10 people who require a bone marrow transplant do not have a matching donor in their family, and
rely on the registry of bone marrow donors to find a match.
The process for matching a patient with a donor involves comparing human leukocyte antigen (HLA) types in
order to find a match.
Several diseases, many of which are incurable, pose a threat to bone marrow and prevent bone marrow from
turning stem cells into essential cells.

What is bone marrow?

Bone marrow is soft, gelatinous tissue that fills the medullary cavities - the centers of
bones. There are two types of bone marrow: red bone marrow (also known as myeloid
tissue) and yellow bone marrow (fatty tissue).1
Both types of bone marrow are highly vascular and enriched with numerous blood
vessels and capillaries.2
The bone marrow makes more than 200 billion new blood cells every day. 8 Most blood
cells in the body develop from cells in the bone marrow.5

Bone marrow stem cells

The bone marrow has two types of stem cells: mesenchymal and hematopoietic.
Red bone marrow consists of a delicate, highly vascular fibrous tissue containing
hematopoietic stem cells, which are blood-forming stem cells. Yellow bone marrow
contains mesenchymal stem cells, also known as marrow stromal cells, which produce
fat, cartilage and bone.4
Stem cells are immature (primitive) cells that have the capacity to turn into a number
of different types of cell. The hematopoietic stem cells in the bone marrow give rise to
two main types of cells: myeloid and lymphoid lineages, which include cells such as
monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes, dendritic
cells, and megakaryocytes or platelets, as well as T cells, B cells, and natural killer
cells.
There are different types of hematopoietic stem cells which vary in terms of
regenerative capacity and potency; some are multipotent, oligopotent or unipotent as
determined by how many types of cell they can create. Pluripotent hematopoietic
stem cells differ from other blood cells due to the following properties:

Renewal: can reproduce another cell identical to itself

Differentiation: can generate one or more subsets of more mature cells.

The process of development of different blood cells from these pluripotent stem cells
is known as hematopoiesis.11
It is these stem cells that are needed in bone marrow transplant.
Stem cells constantly divide and produce new cells. Some new cells remain as stem
cells and others go through a series of maturing stages (precursor or blast cells)
before forming into fully formed (mature) blood cells. Stem cells rapidly multiply to
make millions of blood cells each day.10
Blood cells have a limited life span (around 100-120 days for red blood cells) and are
constantly being replaced. The production of healthy stem cells is vital.12
The blood vessels act as a barrier to prevent immature blood cells from leaving the
bone marrow. Only mature blood cells contain the membrane proteins required to
attach to and pass through the blood vessel endothelium. Hematopoietic stem cells
can cross the bone marrow barrier, however, and may be harvested from peripheral
(circulating) blood.15
The blood-forming stem cells in red bone marrow can multiply and mature into three
significant types of blood cells, each with their own job:

Red blood cells (erythrocytes) - transport oxygen around the body

White blood cells (leukocytes) - help fight infection and disease. White blood cells include
lymphocytes - the cornerstone of the immune system - and myeloid cells which include granulocytes:
neutrophils, monocytes, eosinophils, and basophils

Platelets (thrombocytes) - aid with clotting after injury. Platelets are fragments of the cytoplasm of
megakaryocytes, another bone marrow cell.

Once mature, these blood cells migrate from the marrow and are introduced into the
bloodstream, where they perform important functions required to keep the body alive
and healthy.7
Mesenchymal stem cells are found in the bone marrow cavity and differentiate into a
number of stromal lineages, such as chondrocytes (cartilage generation), osteoblasts
(bone formation), osteoclasts, adipocytes (adipose tissue), myocytes (muscle),
macrophages, endothelial cells and fibroblasts.6

Red bone marrow

All red blood cells and platelets in humans adults are formed in the red bone marrow,
which also produces around 60-70% of lymphocytes (the rest begin life in the red
bone marrow and become fully formed in the lymphatic tissues, including the thymus,
spleen, and lymph nodes.1

Red bone marrow also plays a role in the obliteration of old red blood cells, along with
the liver and spleen.

Yellow bone marrow

Yellow bone marrow's main purpose is to act as a store for fats, helping to provide
sustenance and maintain the correct environment for the bone to function. However,
under particular conditions, such as severe blood loss or fever, the yellow marrow may
revert to red marrow.1
Yellow marrow tends to be located in the central cavities of long bones, and is
generally surrounded by a layer of red marrow with long trabeculae (beam-like
structures) within a sponge-like reticular framework.6

Bone marrow timeline

Bone marrow first develops in the clavicle near the end of fetal development and
becomes active about 3 weeks later. Bone marrow supersedes the liver as the major
hematopoietic organ at 32-36 weeks' gestation.
Bone marrow remains red until around the age of seven as the need for new
continuous blood formation is high. As the body ages, the red marrow is gradually
replaced by yellow fat tissue. Adults have an average of about 2.6 kg (5.7 lbs) of bone
marrow, about half of which is red.3
In adults, the highest concentration of red marrow is in the bones of the vertebrae,
hips (ilium), breastbone (sternum), ribs, skull and at the metaphyseal and epiphyseal
ends of the long bones of the arm (humerus) and leg (femur and tibia). All other
cancellous, or spongy, bones and central cavities of the long bones are filled with
yellow marrow.

What does bone marrow do for your body?

The majority of red blood cells, platelets, and most of the white blood cells are formed
in the red marrow. Yellow bone marrow produce fat, cartilage and bone.
White blood cells survive anywhere from a few hours to a few days, platelets for about
10 days, and red blood cells for about 120 days. These cells must be constantly
replaced by the bone marrow as each blood cell has a set life expectancy.
Certain conditions may trigger additional production of blood cells, such as when the
oxygen content of body tissues is low, if there is loss of blood or anemia, or if the
number of red blood cells decreases. In such cases, the kidneys produce and release
erythropoietin, a hormone that stimulates the bone marrow to produce more red blood
cells.

Similarly, the bone marrow produces and releases more white blood cells in response
to infections, and more platelets in response to bleeding. If a person experiences
serious blood loss, yellow bone marrow can be activated and transformed into red
bone marrow.

Blood cell formation from differentiation of hematopoietic stem cells in red bone marrow.

Healthy bone marrow is important for the following systems and activities:
Circulatory system

The circulatory system touches every organ and system in the body and contains a number of different cells
with a variety of functions. Red blood cells transport oxygen to cells and tissues, platelets are carried in the
blood to help blood clot after injury, and white blood cells are transported to sites of infection or injury.
Hemoglobin

Hemoglobin is the protein in red blood cells that gives them their color. Hemoglobin collects oxygen in the
lungs, transports it in the red blood cells, and releases oxygen to tissues such as the heart, muscles, and
brain. Carbon dioxide (CO2), a waste product of respiration, is also removed by hemoglobin and sent back to
the lungs to be exhaled.

Iron

Iron is an important nutrient for human physiology. It combines with protein to make the hemoglobin in red
blood cells and is essential in the production of red blood cells (erythropoiesis). The body stores iron in the
liver, spleen, and bone marrow. Most of the iron needed each day for making hemoglobin comes from the
recycling of old red blood cells.
Red blood cells

The production of red blood cells is called erythropoiesis. It takes about 7 days for a committed stem cell to
mature into a fully functional red blood cell. As red blood cells age, they become less active and more
fragile.
Aging red cells are removed or eaten up by a type of white blood cell (macrophages) in a process known as
phagocytosis and the contents of these cells are released into the blood. The iron released in this process is
carried to either the bone marrow for production of new red blood cells or to the liver or other tissues for
storage.
Under normal conditions, around 1% of the body's total red blood cells are replaced every day. In a healthy
person, around 200 billion red blood cells are produced each day.
White blood cells

The bone marrow produces many types of white blood cells, which are necessary for a healthy immune
system. These cells both prevent and fight infections.
The main types of white blood cell or leukocytes are:
1) Lymphocytes

Lymphocytes are produced in bone marrow. They make natural antibodies to fight infection caused by
viruses that enter the body through the nose, mouth or other mucous membrane, or through cuts and grazes.
Specific cells recognize the presence of foreign invaders (antigens) that enter the body and send a signal to
other cells to attack the antigens.
The number of lymphocytes increases in response to these invasions. There are two major types of
lymphocyte: B- and T-lymphocytes.
2) Monocytes

Monocytes are also produced in the bone marrow. Mature monocytes have a life expectancy in the blood of
only 3-8 hours, but when they move into the tissues, they mature into larger cells called macrophages.
Macrophages can survive in the tissues for long periods of time where they engulf and destroy bacteria,
some fungi, dead cells, and other material foreign to the body.
3) Granulocytes

Granulocyte is the family or collective name given to three types of white blood cells: neutrophils,
eosinophils and basophils. The development of a granulocyte may take two weeks, but this time is shortened
when there is an increased threat like a bacterial infection.
The bone marrow also stores a large reserve of mature granulocytes. For every granulocyte circulating
within the blood, there may be 50-100 cells waiting in the marrow to be released into the blood stream. As a

result, half the granulocytes in the blood stream can be available to actively fight an infection in the body
within 7 hours of recognizing that an infection exists.
Once a granulocyte has left the blood it does not normally return. A granulocyte may survive in the tissues
for as long as 4-5 days depending on the conditions, but it only survives for a few hours in the circulation.
4) Neutrophils

Neutrophils are the most common granulocyte. They can attack and destroy bacteria and viruses.
5) Eosinophils

Eosinophils are involved in the fight against many types of parasitic infections and against the larvae of
parasitic worms and other organisms. They are also involved in some allergic reactions.
6) Basophils

Basophils are the least common of the white blood cells and respond to various allergens that cause the
release of histamines, heparin and other substances.
Heparin is an anticoagulant (preventing blood from clotting), and histamines are vasodilators that cause
irritation and inflammation. The result of the release of these substances is to and make them more
permeable, and allowing for white blood cells and proteins to enter tissues to engage the pathogen.
The irritation and inflammation in tissues affected by an allergen is part of the reaction seen in hay fever,
some forms of asthma, hives, and in its most serious form, anaphylactic shock.
Platelets

Platelets are produced in bone marrow by a process known as thrombopoiesis. Platelets are critical to blood
coagulation and the formation of clots to stop bleeding.
Sudden blood loss triggers platelet activity at the site of an injury or wound. Here, the platelets clump
together and combine with other substances to form fibrin. Fibrin has a thread-like structure and forms an
external scab or clot.
Platelet deficiency causes the body to bruise and bleed more easily. Blood may not clot well at an open
wound, and there may be a greater risk for internal bleeding if the platelet count is very low.
Lymphatic system

The lymphatic system is made up of lymphatic organs such as bone marrow, the tonsils, the thymus, the
spleen and lymph nodes.
All lymphocytes develop in the bone marrow from immature cells called stem cells. Lymphocytes that
mature in the thymus gland (behind the breastbone) are called T-cells. Lymphocytes that mature in the bone
marrow or lymphatic organs are called B-cells.14
Immune system

Our immune system protects the body from disease. It kills unwanted micro-organisms such as bacteria and
viruses that may invade the body.

How does our immune system fight against infection?

Small glands called lymph nodes are scattered throughout the body, and once lymphocytes are made in the
marrow, they travel to the lymph nodes. The lymphocytes can then travel between each node through
lymphatic channels that meet at large drainage ducts that empty into a blood vessel. Lymphocytes enter the
blood through these ducts.
There are three major types of lymphocytes, which play an important part of the immune system:
B-lymphocytes (B-cells)

There are three types lymphocytes. T-lymphocytes, B-lymphocytes and natural killer cells.

These cells originate from hematopoietic stem cells in the bone marrow in mammals. B-cells express B-cell
receptors (BCRs) on the surface of the cells which allow the cell to attach to an antigen on the surface of an
invading microbe or other antigenic agent. For this reason, B-cells are known as antigen-presenting cells as
they alert other cells of the immune system to an invading microbe.
B-cells also secrete antibodies which attach to the surface of infection-causing microbes. These antibodies
are Y-shaped, and each one is akin to a specialized "lock" into which a matching antigen "key" fits. As such,
each Y-shaped antibody reacts to a different microbe, triggering a larger immune system response with the
aim of fighting infection.

In some circumstances, B-cells erroneously identify the normal cells of the human body as being antigens
that require an immune system response. This is the mechanism that lies behind the development of
autoimmune diseases such as multiple sclerosis, scleroderma and type 1 diabetes.
T-lymphocytes (T-cells)

These cells are so-called because they mature in the thymus, a small organ in the upper chest, just behind the
sternum (some T-cells mature in the tonsils). There are many different types of T-cells, and they perform a
range of functions as part of adaptive cell-mediated immunity. T-cells help B-cells make antibodies against
invading bacteria, viruses, or other microbes.
Unlike B-cells, some T-cells engulf and destroy pathogens directly, after binding to the antigen on the
surface of the microbe.
Natural killer T-cells, not to be confused with natural killer cells of the innate immune system, bridge the
adaptive and innate immune systems. NKT cells recognize antigens presented in a different way to many
other antigens, and can perform the functions of T-helper cells and cytotoxic T-cells. They can also
recognize and eliminate some tumor cells.
Natural killer (NK) cells

These are a type of lymphocyte that directly attacks cells which have been infected by a virus.

What are bone marrow tests?

Examination of the bone marrow is helpful in diagnosing certain diseases, especially those related to blood
and blood-forming organs. Testing provides information on iron stores and blood production.1
Bone marrow aspiration uses a hollow needle to remove a small sample (about 1 ml) of bone marrow for
examination under a microscope. The needle is usually inserted into the hip or sternum in adults and into the
upper part of the tibia (the larger bone of the lower leg) in children and suction is used to extract the sample.
Bone marrow aspiration is typically performed when indicated by previous blood tests and is particularly
useful in providing information on various stages of immature blood cells.
Disorders in which bone marrow examination is of special diagnostic value include:1

Leukemia

Multiple myeloma

Gaucher disease

Unusual cases of anemia

Other hematological diseases.

http://www.medicalnewstoday.com/articles/285666.php