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Development of the Hematopoietic System & Blood Cell Counts Dr.Jie Yu, MD. Professor The department of Pediatric, Hematology/Oncology HEMATOLOGY/ONCOLOGY,

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Presentation on theme: "Development of the Hematopoietic System & Blood Cell Counts Dr.Jie Yu, MD. Professor The department of Pediatric, Hematology/Oncology HEMATOLOGY/ONCOLOGY,"— Presentation transcript:

1 Development of the Hematopoietic System & Blood Cell Counts Dr.Jie Yu, MD. Professor The department of Pediatric, Hematology/Oncology HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

2 Contents 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, CHILDREN’S HOSPITAL

3 Development of Hematopoietic System HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

4 HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

5 In the embryo and fetus, constant changes characterize all phases of hematopoiesis. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

6 Development of Hematopoietic Organs Fetal hematopoiesis –Mesoblastic Hematopoiesis –Hepatic Hematopoiesis –Myeloid Hematopoiesis Hematopoiesis after birth HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

7 Development of Hematopoietic Organs Fetal Hematopoiesis liver

8 SITESTIMEPRODUC Measoblastic hematopoisis Yolk Sac10-14 th 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. Fetal Hematopoiesis HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

9 Development of Hematopoietic Organs Fetal hematopoiesis Hematopoiesis after birth –Bone marrow hematopoiesis –Extrmedullary hematopoiesis HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

10 Development of Hematopoietic 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, CHILDREN’S HOSPITAL

11 Development of Hematopoietic 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, CHILDREN’S HOSPITAL

12 Development of the Hematopoietic 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, CHILDREN’S HOSPITAL

13 Table 2.The Development of Blood Cells PROGENITORCYTOKINESPRODUC CFU-GMG-CSFNUTROPHIL CFU-MegTPOPLT CFU-E BFU-E EPORBC HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

14 Fig 1.Hematopoisis

15 HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

16 Blood Cell Counts and Hemoglobin HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

17 Fig2. Peripheral Blood Cells HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

18 RBC and Hb Level At Birth: –RBC: 5-7x10 12 /L –Hb:150 to 230g/L. Postnatal fall /physiology anemia Infancy  Preschool age: –RBC: 4 x 10 12 /L –Hb: 110 g/L 7-12yr: adult level HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

19 RBC 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, CHILDREN’S HOSPITAL

20 RBC 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, CHILDREN’S HOSPITAL

21 HEMOGLOBIN. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Function – transport oxygen. Construction –iron-containing heme plus globins which is a tetramer made up of two pairs of polypeptide chains,

22 Table3. HEMOGLOBINS HbChains 8周8周 6月6月出生 6-12 月 2岁2岁 EmbryGower1ζ2ε2ζ2ε2 8 周前, 3 月消 失 Gower2α2ε2α2ε2 Portlanζ2γ2ζ2γ2 FetalHbFα2γ2α2γ2 增加 90%70%<5%<2% AdultHbAα2β2α2β2 5-10%30%>95% HbA 2 α2δ2α2δ2 <1%2-3%<3.5% >95% HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

23 WBC Counts At birth: 20 x 10 9 /L Infant: 12 x 10 9 /L Preschool: 8.0 x 10 9 /L HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

24 (%)70 淋巴细胞 中性粒细胞 4-6 岁 4-6 天 60 50 40 30 20 10 1 3 5 7 9 日数 1 3 5 7 9 11 岁数 Fig4. WBC Ratio HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

25 PLT & Blood Volume PLT: 150-250 x 10 9 /L Blood Volume: –Term newborn: 85ml/kg –Premature infant: 95ml/kg –Adult: 75ml/kg –Young children: 75-80ml/kg HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

26 The Introduction of ANEMIA HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

27 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, CHILDREN’S HOSPITAL

28 AgeAnemia ValuesAnemia Degree Newborn< 145g/L 1-4 mo< 90g/LMild: -90g/L 4-6 mo< 100g/LModerate: -60g/L 6 mo-6 yr< 110g/LSevere: -30g/L 6-14 yr< 120g/LExtremelysevere:<30g/L HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Table 4. The definition of Anemia and Degree

29 Pathophysiology –increased cardiac output –increased oxygen extraction –blood flow toward vital organs and tissues. –In addition, the concentration of 2,3- DPG increases within the RBC. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Pathophysiology of Anemia Self study

30 Fig5:The oxygen dissociation curve HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Self study

31 Manifestation of Anemia Acute onset –elevated pulse, hemic flow murmur, poor exercise tolerance, headache, excessive sleeping, poor feeding, and syncope may occur. Slow onset – weakness, tachypnea, shortness of breath on exertion, tachycardia, cardiac dilatation, and congestive heart failure HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Self study

32 MCV ( fl ) MCH ( pg ) MCHC ( % ) Normal ranges 80-94 28-32 32-38 Macrocytic >94 >32 32-38 Normocromic /Normocytic 80-94 28-32 32-38 Microcytic <80 <28 32-28 Hypochromic /Microcytic <80 <28< 32 Classification-morphology Table 5 HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

33 Classification- Etiology Reduced capacity to produce red blood cells Hemolysis Blood Loss HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

34 Classification- etiology Reduced capacity to produce RBC –Aplastic anemia Fanconi’s anemia Acquired aplastic anemia –Pure red cell aplasia congenital hypoplastic anemia (Diamond-Blackfan) Acquired hypoplastic anemia HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

35 Classification- etiology Reduced capacity to produce RBC –Marrow Infiltration Leukemia Lymphoma Neuroblastom LCH HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

36 Classification-etiology Reduced capacity to produce RBC –Deficiency Syndrome Iron Folate Vitamin B 12 Vitamin E Vitamin B 6 HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

37 Classification-etiology Hemolysis –Iintrinsic RBC abnormalities Hemoglobinopathies Enzymopathies Membrane disorders –extrinsic RBC abnormalities Immunologic: AIHA HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

38 Classification-etiology Hemolysis:intrinsic RBC abnormalities –Intrinsic membrane defects Hereditary Spherocytosis:Hereditary Spherocytosis –Hemoglobinopathy Thalassemia –RBC enzyme defects G6PD defect HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

39 Classification-etiology Hemolysis:extrinsic RBC abnormalities –Immunologic hemolysis Isoimmune (Rh, ABO in neonate) Autoimmune Hemolytic Anemia (AIHA) HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

40 Classification-etiology Blood loss –Gastrointestinal bleeding Ankylostomiasis –Menstrual –Trauma HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

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42 Hematopoiesis Related Terms CFU-GM –colony –forming units granulocyte-macrophages CFU-Meg –colony-forming unite-megakaryocyte CFU-E –colony-forming units-erythroid BFU-E –burst-forming units-erythroid G-CSF –colony-stimulating factor TPO –thrombopoietin EPO –erythropoietin

43 RBC Index MCV –Mean corpuscular volume MCH –Mean corpuscular hemoglobin MCHC –Mean corpuscular concertration HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

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