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1、Development of the Hematopoietic System & Blood Cell CountsDr.Jie Yu, MD. ProfessorThe department of Pediatric, Hematology/Oncology HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALContentsnDevelopment of hematopoietic systemnHematopoietic organsnHematopoietic blood cellsnCharacteristic of cell counts and hem
2、oglobinnRBC and Hb levelnHemoglobinnWBC/Platelet/Blood volumen AnemiaHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of Hematopoietic SystemHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITAL In the embryo and fetus,constant changes characterize all phases of hematopoie
3、sis. HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of Hematopoietic Organs Fetal hematopoiesisMesoblastic Hematopoiesis Hepatic Hematopoiesis Myeloid Hematopoiesis Hematopoiesis after birth HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansFetalHematopoiesisliverSITESTIM
4、EPRODUCMeasoblastichematopoisisYolkSac10-14thday3-4wk:primitiveblasts10-12wk:ceasedErythroidHepatichematopoiesisLiverSpleen6-8wk:appear12-16wk:active6mo:diminish/stopatbirthErythroidMyeloidhematopoiesisBonemarrow4mo:start6mo:increase/steadyafterbirth:theonlyErythroidNeutrophilsMacrophagesTable 1. Fe
5、tal HematopoiesisHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansFetal hematopoiesisHematopoiesis after birthBone marrow hematopoiesisExtrmedullary hematopoiesisHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansHematopoiesis after birthBone marrow he
6、matopoiesisAll blood cells are produced in the marrow after 2nd trimester Newborn and early infancy: red marrow 5-7yr : yellow marrowExtramedullary hematopoiesisHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansHematopoiesis after birthBone marrow hematopoiesisExtramedullary
7、hematopoiesisIn diseases status: red cell production hematopoietic tissue. blood production expands to replace fatty marrow. blood cells production extends to extramedullary sites ( liver and spleen). HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDevelopment of the Hematopoietic Blood CellsPluripotent Stem
8、 Cells: which are capable of both self-renewal and of clonal maturation into all blood cell lineages. Progenitor cells differentiate under the influence of hematopoietic growth factorsHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALTable2.TheDevelopmentofBloodCellsPROGENITORCYTOKINESPRODUCCFU-GMG-CSFNUTROPHI
9、LCFU-MegTPOPLTCFU-EBFU-EEPORBCHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALFig1.HematopoisisHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALBlood Cell Counts and Hemoglobin HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALFig2. Peripheral Blood CellsHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPI
10、TALRBC and Hb LevelAt Birth: RBC: 5-7x1012/L Hb:150 to 230g/L. Postnatal fall /physiology anemiaInfancy Preschool age:RBC: 4 x 1012/L Hb: 110 g/L 7-12yr: adult levelHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALRBC and Hb levelPhysiological Anemia. Hemoglobin values in term infants drop to their lowest mea
11、n of 100g/L at 2-3 mo Causes Erythropoietin production Red cell life span (90/120) Blood volume Preterm infant HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALRBC and Hb levelReticulocytesAt Birth: 5% / 10%1-2mo: fall down to 0.3%Later adult level: 0.5-1.5%Nucleated Red Blood CellsAt birth: 3-10/100 WBC; 10-
12、20/100WBC1wk: disappearHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITAL HEMOGLOBIN. HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALFunction transport oxygen. Constructioniron-containing heme plus globins which is a tetramer made up of two pairs of polypeptide chains, Table3. HEMOGLOBINSHbChains8周周6月月出生出生6-12月月2岁岁Emb
13、ryGower1228周前，周前，3月消月消失失Gower222Portlan22FetalHbF22增加增加90%70%5%95%HbA2221%2-3%95%HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALWBC CountsAt birth: 20 x 109/LInfant: 12 x 109/LPreschool: 8.0 x 109/LHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITAL(%)70淋巴细胞淋巴细胞中性粒细胞中性粒细胞4-6岁岁4-6天天60504030201013579日数日数1357911岁数岁数Fig4.
14、WBC RatioHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALPLT & Blood VolumePLT: 150-250 x 109/LBlood Volume: Term newborn: 85ml/kgPremature infant: 95ml/kgAdult: 75ml/kgYoung children: 75-80ml/kgHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALThe Introduction of ANEMIAHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALDefinition
15、 of Anemia A reduction of the red blood cell volume or hemoglobin concentration below the range of values occurring in healthy persons HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALAgeAnemiaValuesAnemiaDegreeNewborn145g/L1-4mo90g/LMild:-90g/L4-6mo100g/LModerate:-60g/L6mo-6yr110g/LSevere:-30g/L6-14yr120g/LE
16、xtremelysevere:943232-38Normocromic/Normocytic80-9428-3232-38Microcytic802832-28Hypochromic/Microcytic802832Classification-morphologyTable5HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification- Etiology Reduced capacity to produce red blood cellsHemolysis Blood LossHEMATOLOGY/ONCOLOGY, CHILDRENS HOS
17、PITALClassification- etiology Reduced capacity to produce RBCAplastic anemiaFanconis anemiaAcquired aplastic anemiaPure red cell aplasiacongenital hypoplastic anemia (Diamond-Blackfan)Acquired hypoplastic anemiaHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification- etiologyReduced capacity to produc
18、e RBCMarrow InfiltrationLeukemiaLymphomaNeuroblastomLCHHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification-etiology Reduced capacity to produce RBCDeficiency SyndromeIron FolateVitamin B12Vitamin EVitamin B6HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification-etiologyHemolysisIintrinsic RBC abnor
19、malitiesHemoglobinopathiesEnzymopathiesMembrane disordersextrinsic RBC abnormalitiesImmunologic: AIHAHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification-etiologyHemolysis:intrinsic RBC abnormalitiesIntrinsic membrane defectsHereditary Spherocytosis: HemoglobinopathyThalassemiaRBC enzyme defectsG6P
20、D defectHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification-etiologyHemolysis:extrinsic RBC abnormalitiesImmunologic hemolysis Isoimmune (Rh, ABO in neonate) Autoimmune Hemolytic Anemia (AIHA)HEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALClassification-etiologyBlood lossGastrointestinal bleeding Ankylost
21、omiasisMenstrualTraumaHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHematopoiesis Related TermsCFU-GMcolony forming units granulocyte-macrophagesCFU-Megcolony-forming unite-megakaryocyteCFU-Ecolony-forming units-erythroidBFU-Ebur
22、st-forming units-erythroidG-CSFcolony-stimulating factorTPOthrombopoietinEPOerythropoietinRBC IndexMCVMeancorpuscularvolumeMCHMeancorpuscularhemoglobinMCHCMeancorpuscularconcertrationHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY, CHILDRENS HOSPITAL
