医学专题一小儿造血和血液特点(英文).ppt
Development of the Hematopoietic System&Blood Cell CountsDr.Jie Yu,MD.ProfessorThe department of Pediatric,Hematology/Oncology HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第一页，共五十三页。ContentsnDevelopment of hematopoietic systemnHematopoietic organsnHematopoietic blood cellsnCharacteristic of cell counts and hemoglobinnRBC and Hb levelnHemoglobinnWBC/Platelet/Blood volumen AnemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第二页，共五十三页。Development of Hematopoietic SystemHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四页，共五十三页。In the embryo and fetus,constant changes characterize all phases of hematopoiesis.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第五页，共五十三页。Development of Hematopoietic Organs Fetal hematopoiesisMesoblastic Hematopoiesis Hepatic Hematopoiesis Myeloid Hematopoiesis Hematopoiesis after birth HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第六页，共五十三页。Development of Hematopoietic OrgansFetalHematopoiesisliver第七页，共五十三页。SITESTIMEPRODUCMeasoblastichematopoisisYolkSac10-14thday3-4wk:primitiveblasts10-12wk:ceasedErythroidHepatichematopoiesisLiverSpleen6-8wk:appear12-16wk:active6mo:diminish/stopatbirthErythroidMyeloidhematopoiesisBonemarrow4mo:start6mo:increase/steadyafterbirth:theonlyErythroidNeutrophilsMacrophagesTable 1.Fetal HematopoiesisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第八页，共五十三页。Development of Hematopoietic OrgansFetal hematopoiesisHematopoiesis after birthBone marrow hematopoiesisExtrmedullary hematopoiesisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第九页，共五十三页。Development of Hematopoietic OrgansHematopoiesis after birthBone marrow hematopoiesisAll blood cells are produced in the marrow after 2nd trimester Newborn and early infancy:red marrow 5-7yr:yellow marrowExtramedullary hematopoiesisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第十页，共五十三页。Development of Hematopoietic OrgansHematopoiesis after birthBone marrow hematopoiesisExtramedullary 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 HOSPITAL第十一页，共五十三页。Development of the Hematopoietic Blood CellsPluripotent 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 factorsHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第十二页，共五十三页。Table2.TheDevelopmentofBloodCellsPROGENITORCYTOKINESPRODUCCFU-GMG-CSFNUTROPHILCFU-MegTPOPLTCFU-EBFU-EEPORBCHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第十三页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFig1.Hematopoisis第十四页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第十五页，共五十三页。Blood Cell Counts and Hemoglobin HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第十六页，共五十三页。Fig2.Peripheral Blood CellsHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第十七页，共五十三页。RBC 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 HOSPITAL第十八页，共五十三页。RBC and Hb levelPhysiological 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第十九页，共五十三页。RBC 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;10-20/100WBC1wk:disappearHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第二十页，共五十三页。HEMOGLOBIN.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFunction transport oxygen.Constructioniron-containing heme plus globins which is a tetramer made up of two pairs of polypeptide chains,第二十一页，共五十三页。Table3.HEMOGLOBINSHbChains8周周6月月出生出生6-12月月2岁岁EmbryGower1228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 HOSPITAL第二十二页，共五十三页。WBC CountsAt birth:20 x 109/LInfant:12 x 109/LPreschool:8.0 x 109/LHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第二十三页，共五十三页。(%)70淋巴细胞淋巴细胞中性中性(zhngxng)粒粒细胞细胞4-6岁岁4-6天天60504030201013579日数日数1357911岁数岁数(sushu)Fig4.WBC RatioHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第二十四页，共五十三页。PLT&Blood VolumePLT:150-250 x 109/LBlood Volume:Term newborn:85ml/kgPremature infant:95ml/kgAdult:75ml/kgYoung children:75-80ml/kgHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第二十五页，共五十三页。The Introduction of ANEMIAHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第二十六页，共五十三页。Definition 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第二十七页，共五十三页。AgeAnemiaValuesAnemiaDegreeNewborn145g/L1-4mo90g/LMild:-90g/L4-6mo100g/LModerate:-60g/L6mo-6yr110g/LSevere:-30g/L6-14yr120g/LExtremelysevere:943232-38Normocromic/Normocytic80-9428-3232-38Microcytic802832-28Hypochromic/Microcytic802832Classification-morphologyTable5HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十二页，共五十三页。Classification-Etiology Reduced capacity to produce red blood cellsHemolysis Blood LossHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十三页，共五十三页。Classification-etiology Reduced capacity to produce RBCAplastic anemiaFanconis anemiaAcquired aplastic anemiaPure red cell aplasiacongenital hypoplastic anemia (Diamond-Blackfan)Acquired hypoplastic anemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十四页，共五十三页。Classification-etiologyReduced capacity to produce RBCMarrow InfiltrationLeukemiaLymphomaNeuroblastomLCHHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十五页，共五十三页。Classification-etiology Reduced capacity to produce RBCDeficiency SyndromeIron FolateVitamin B12Vitamin EVitamin B6HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十六页，共五十三页。Classification-etiologyHemolysisIintrinsic RBC abnormalitiesHemoglobinopathiesEnzymopathiesMembrane disordersextrinsic RBC abnormalitiesImmunologic:AIHAHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十七页，共五十三页。Classification-etiologyHemolysis:intrinsic RBC abnormalitiesIntrinsic membrane defectsHereditary Spherocytosis:HemoglobinopathyThalassemiaRBC enzyme defectsG6PD defectHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十八页，共五十三页。Classification-etiologyHemolysis:extrinsic RBC abnormalitiesImmunologic hemolysis Isoimmune(Rh,ABO in neonate)Autoimmune Hemolytic Anemia(AIHA)HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第三十九页，共五十三页。Classification-etiologyBlood lossGastrointestinal bleeding AnkylostomiasisMenstrualTraumaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十一页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHematopoiesis Related TermsCFU-GMcolony forming units granulocyte-macrophagesCFU-Megcolony-forming unite-megakaryocyteCFU-Ecolony-forming units-erythroidBFU-Eburst-forming units-erythroidG-CSFcolony-stimulating factorTPOthrombopoietinEPOerythropoietin第四十二页，共五十三页。RBC IndexMCVMeancorpuscularvolumeMCHMeancorpuscularhemoglobinMCHCMeancorpuscularconcertrationHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十三页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十四页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十五页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十六页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十七页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十八页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第四十九页，共五十三页。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL第五十页，共五十三页。第五十一页，共五十三页。第五十二页，共五十三页。内容(nirng)总结Development of the Hematopoietic System&Blood Cell Counts。HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL。WBC/Platelet/Blood volume。Hb:150 to 230g/L.。7-12yr:adult level。22。Young children:75-80ml/kg。MCHC第五十三页，共五十三页。
