The stroma of the bone marrow is all tissue not directly involved in the marrow's primary function

of hematopoiesis.[6] Yellow bone marrow makes up the majority of bone marrow stroma, in
addition to smaller concentrations of stromal cells located in the red bone marrow. Though not as
active as parenchymal red marrow, stroma is indirectly involved in hematopoiesis, since it
provides the hematopoietic microenvironment that facilitates hematopoiesis by the parenchymal
cells. For instance, they generate colony stimulating factors, which have a significant effect
on hematopoiesis. Cell types that constitute the bone marrow stroma include:

fibroblasts (reticular connective tissue)

macrophages, which contribute especially to red blood cell production, as they

deliver iron for hemoglobin production.

adipocytes (fat cells)

osteoblasts (synthesize bone)

osteoclasts (resorb bone)

endothelial cells, which form the sinusoids. These derive from endothelial stem cells,
which are also present in the bone marrow.[7]

Cellular components[edit]
Hematopoietic precursor cells:promyelocyte in the center, twometamyelocytes next to it and band cellsfrom
a bone marrow aspirate.

Cellular constitution of the red bone marrow parenchyma[8]

Group

Myelopoietic

Cell type

Average

Reference

fraction

range

Myeloblasts

0.9%

0.2-1.5

Promyelocytes

3.3%

2.1-4.1

Neutrophilic myelocytes

12.7%

8.2-15.7

cells

Eosinophilic myelocytes

0.8%

0.2-1.3

Neutrophilic metamyelocytes

15.9%

9.6-24.6

Eosinophilic metamyelocytes

1.2%

0.4-2.2

Neutrophilic band cells

12.4%

9.5-15.3

Eosinophilic band cells

0.9%

0.2-2.4

Segmented neutrophils

7.4%

6.0-12.0

Segmented eosinophils

0.5%

0.0-1.3

Segmented basophils and mast cells

0.1%

0.0-0.2

Pronormoblasts

0.6%

0.2-1.3

Basophilic normoblasts

1.4%

0.5-2.4

Polychromatic normoblasts

21.6%

17.9-29.2

Orthochromatic normoblast

2.0%

0.4-4.6

Megakaryocytes

< 0.1%

0.0-0.4

Plasma cells

1.3%

0.4-3.9

Reticular cells

0.3%

0.0-0.9

Erythropoietic
cells

Other cell
types

Lymphocytes

16.2%

11.1-23.2

Monocytes

0.3%

0.0-0.8

In addition, the bone marrow contains hematopoietic stem cells, which give rise to the three
classes of blood cells that are found in the circulation: white blood cells (leukocytes),red blood
cells (erythrocytes), and platelets (thrombocytes).[7]

Function[edit]
Mesenchymal stem cells[edit]
Main article: Mesenchymal stem cell
The bone marrow stroma contains mesenchymal stem cells (MSCs),[7] also known as marrow
stromal cells. These are multipotent stem cells that can differentiate into a variety of cell types.
MSCs have been shown to differentiate, in vitro or in vivo,
into osteoblasts, chondrocytes, myocytes, adipocytes and beta-pancreatic islets cells.

Bone marrow barrier[edit]

The blood vessels of the bone marrow constitute a barrier, inhibiting immature blood cells from
leaving the marrow. Only mature blood cells contain the membrane proteins, such
as aquaporin and glycophorin, that are required to attach to and pass the blood
vessel endothelium.[9] Hematopoietic stem cells may also cross the bone marrow barrier, and
may thus be harvested from blood.

Lymphatic role[edit]
The red bone marrow is a key element of the lymphatic system, being one of the primary
lymphoid organs that generate lymphocytes from immature hematopoietic progenitor cells.[3] The
bone marrow and thymus constitute the primary lymphoid tissues involved in the production and
early selection of lymphocytes. Furthermore, bone marrow performs a valve-like function to
prevent the backflow of lymphatic fluid in the lymphatic system.

Compartmentalization[edit]
Biological compartmentalization is evident within the bone marrow, in that certain cell types tend
to aggregate in specific areas. For instance, erythrocytes, macrophages, and
their precursors tend to gather around blood vessels, while granulocytes gather at the borders of
the bone marrow.[7]

Society and culture[edit]

Animal bone marrow has been used in cuisine worldwide for millennia, such as the
famed Milanese Ossobuco.[citation needed]

Clinical significance[edit]
Disease[edit]
The normal bone marrow architecture can be damaged or displaced by aplastic
anemia, malignancies such as multiple myeloma, or infections such as tuberculosis, leading to a
decrease in the production of blood cells and blood platelets. The bone marrow can also be
affected by various forms of leukemia, which attacks its hematologic progenitor cells.
[10]

Furthermore, exposure to radiation or chemotherapy will kill many of the rapidly dividing cells

of the bone marrow, and will therefore result in a depressed immune system. Many of the
symptoms of radiation poisoning are due to damage sustained by the bone marrow cells.
To diagnose diseases involving the bone marrow, a bone marrow aspiration is sometimes
performed. This typically involves using a hollow needle to acquire a sample of red bone marrow
from the crest of the ilium under general or local anesthesia.[11]

Imaging[edit]
On CT and plain film, marrow change can be seen indirectly by assessing change to the adjacent
ossified bone. Assessment with MRI is usually more sensitive and specific for pathology,
particularly for hematologic malignancies like leukemia and lymphoma. These are difficult to
distinguish from the red marrow hyperplasia of hematopoiesis, as can occur with tobacco
smoking, chronically anemic disease states like sickle cell anemia or beta thalassemia,
medications such as granulocyte colony-stimulating factors, or during recovery from chronic
nutritional anemias or therapeutic bone marrow suppression.[12] On MRI, the marrow signal is not
supposed to be brighter than the adjacent intervertebral disc on T1 weighted images, either in
the coronal or sagittal plane, where they can be assessed immediately adjacent to one another.
[13]

Fatty marrow change, the inverse of red marrow hyperplasia, can occur with normal aging,

[14]

though it can also be seen with certain treatments such as radiation therapy. Diffuse marrow

T1 hypointensity without contrast enhancement or cortical discontinuity suggests red marrow

conversion or myelofibrosis. Falsely normal marrow on T1 can be seen with diffuse multiple
myeloma orleukemic infiltration when the water to fat ratio is not sufficiently altered, as may be
seen with lower grade tumors or earlier in the disease process.[15]

Histology[edit]
Main article: Bone marrow examination

A Wright's-stainedbone marrow aspirate smear from a patient withleukemia.

Bone marrow examination is the pathologic analysis of samples of bone marrow obtained
via biopsy and bone marrow aspiration. Bone marrow examination is used in the diagnosis of a
number of conditions, including leukemia, multiple myeloma, anemia, and pancytopenia. The
bone marrow produces the cellular elements of the blood, including platelets, red blood
cells and white blood cells. While much information can be gleaned by testing the blood itself
(drawn from a vein by phlebotomy), it is sometimes necessary to examine the source of the

blood cells in the bone marrow to obtain more information on hematopoiesis; this is the role of
bone marrow aspiration and biopsy.
The ratio between myeloid series and erythroid cells is relevant to bone marrow function, and
also to diseases of the bone marrow and peripheral blood, such as leukemia and anemia. The
normal myeloid-to-erythroid ratio is around 3:1; this ratio may increase in myelogenous
leukemias, decreas