小儿造血和血液特点(英文).ppt

Development of the Development of the Hematopoietic SystemHematopoietic System&Blood Cell CountsBlood Cell Counts Dr.Jie Yu,MD.Professor The department of Pediatric,Hematology/Oncology HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL ContentsContents Development of hematopoietic system Hematopoietic organs Hematopoietic blood cells Characteristic of cell counts and hemoglobin RBC and Hb level Hemoglobin WBC/Platelet/Blood volume Anemia HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Development of Development of Hematopoietic SystemHematopoietic System HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL In the embryo and fetus,constant changes characterize all phases of hematopoiesis.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Development of Development of Hematopoietic OrgansHematopoietic Organs Fetal hematopoiesis Mesoblastic Hematopoiesis Hepatic Hematopoiesis Myeloid Hematopoiesis Hematopoiesis after birth HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Development of Development of Hematopoietic OrgansHematopoietic Organs Fetal Hematopoiesis liver SITES TIME PRODUC Measoblastic hematopoisis Yolk Sac 10-14th day 3-4wk:primitive blasts 10-12wk:ceased Erythroid Hepatic hematopoiesis Liver Spleen 6-8wk:appear 12-16wk:active 6mo:diminish/stop at birth Erythroid Myeloid hematopoiesis Bone marrow 4mo:start 6mo:increase/steady after birth:the only Erythroid Neutrophils Macrophages Table 1.Table 1.Fetal HematopoiesisFetal Hematopoiesis HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Development of Development of Hematopoietic OrgansHematopoietic Organs Fetal hematopoiesis Hematopoiesis after birth Bone marrow hematopoiesis Extrmedullary hematopoiesis HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Development of Development of Hematopoietic OrgansHematopoietic Organs Hematopoiesis after birth Bone marrow hematopoiesis All blood cells are produced in the marrow after 2nd trimester Newborn and early infancy:red marrow 5-7yr:yellow marrow Extramedullary hematopoiesis HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Development of Development of Hematopoietic OrgansHematopoietic Organs Hematopoiesis after birth Bone marrow hematopoiesis Extramedullary hematopoiesis In 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 HOSPITAL Development of the Development of the Hematopoietic Blood CellsHematopoietic Blood Cells Pluripotent Stem 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 factors HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Table 2.The Development of Blood Cells PROGENITOR CYTOKINES PRODUC CFU-GM G-CSF NUTROPHIL CFU-Meg TPO PLT CFU-E BFU-E EPO RBC HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Fig1.Hematopoisis HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Blood Cell Counts and Hemoglobin HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Fig2.Peripheral Blood Cells HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL RBC and Hb LevelRBC and Hb Level At Birth:RBC:5-7x1012/L Hb:150 to 230g/L.Postnatal fall/physiology anemia Infancy Preschool age:RBC:4 x 1012/L Hb:110 g/L 7-12yr:adult level HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL RBC and Hb levelRBC and Hb level Physiological Anemia.Hemoglobin values in term infants drop to their lowest mean of 100g/L at 2-3 mo Causes Erythropoietin production Red cell life span(90/120)Blood volume Preterm infant HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL RBC and Hb levelRBC and Hb level Reticulocytes At Birth:5%/10%1-2mo:fall down to 0.3%Later adult level:0.5-1.5%Nucleated Red Blood Cells At birth:3-10/100 WBC;10-20/100WBC 1wk:disappear HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL HEMOGLOBINHEMOGLOBIN.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Function transport oxygen.Construction iron-containing heme plus globins which is a tetramer made up of two pairs of polypeptide chains,Table3.HEMOGLOBINSTable3.HEMOGLOBINS Hb Chains 8周周 6月月 出生出生 6-12月月 2岁岁 Embry Gower1 22 8周前，周前，3月消月消失失 Gower2 22 Portlan 22 Fetal HbF 22 增加增加 90%70%5%95%HbA2 22 1%2-3%95%HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL WBC CountsWBC Counts At birth:20 x 109/L Infant:12 x 109/L Preschool:8.0 x 109/L HEMATOLOGY/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 60 50 40 30 20 10 1 3 5 7 9 日数日数 1 3 5 7 9 11 岁数岁数 Fig4.WBC RatioFig4.WBC Ratio HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL PLT&Blood VolumePLT&Blood Volume PLT:150-250 x 109/L Blood Volume:Term newborn:85ml/kg Premature infant:95ml/kg Adult:75ml/kg Young children:75-80ml/kg HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL The Introduction of The Introduction of ANEMIAANEMIA HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL Definition of AnemiaDefinition 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 HOSPITAL Age Anemia Values Anemia D