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1、小儿造血和血液特点(英文)Development of Hematopoietic SystemHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL In the embryo and fetus,constant changes characterize all phases of hematopoiesis.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDevelopment of Hematopoietic Organs Fetal hematopoiesis
2、Mesoblastic Hematopoiesis Hepatic Hematopoiesis Myeloid Hematopoiesis Hematopoiesis after birth HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansFetalHematopoiesisliverSITESTIMEPRODUCMeasoblastichematopoisisYolkSac10-14thday3-4wk:primitiveblasts10-12wk:ceasedErythroidHepatich
3、ematopoiesisLiverSpleen6-8wk:appear12-16wk:active6mo:diminish/stopatbirthErythroidMyeloidhematopoiesisBonemarrow4mo:start6mo:increase/steadyafterbirth:theonlyErythroidNeutrophilsMacrophagesTable 1.Fetal HematopoiesisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansFetal hemat
4、opoiesisHematopoiesis after birthBone marrow hematopoiesisExtrmedullary hematopoiesisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansHematopoiesis after birthBone marrow hematopoiesisAll blood cells are produced in the marrow after 2nd trimester Newborn and early infancy:red
5、 marrow 5-7yr:yellow marrowExtramedullary hematopoiesisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDevelopment of Hematopoietic OrgansHematopoiesis after birthBone marrow hematopoiesisExtramedullary hematopoiesisIn diseases status:red cell production hematopoietic tissue.blood production expands to replac
6、e fatty marrow.blood cells production extends to extramedullary sites(liver and spleen).HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDevelopment of the Hematopoietic Blood CellsPluripotent Stem Cells:which are capable of both self-renewal and of clonal maturation into all blood cell lineages.Progenitor cel
7、ls differentiate under the influence of hematopoietic growth factorsHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALTable2.TheDevelopmentofBloodCellsPROGENITORCYTOKINESPRODUCCFU-GMG-CSFNUTROPHILCFU-MegTPOPLTCFU-EBFU-EEPORBCHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFig1.Hemato
8、poisisHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALBlood Cell Counts and Hemoglobin HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFig2.Peripheral Blood CellsHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALRBC and Hb LevelAt Birth:RBC:5-7x1012/L Hb:150 to 230g/L.Postnatal fall/physiology anemiaInfancy Preschool age:RBC:4 x 1
9、012/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 mean of 100g/L at 2-3 mo Causes Erythropoietin production Red cell life span(90/120)Blood volume Preterm infant HEMATOLOGY/ONCOLOGY,CHI
10、LDRENS 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;10-20/100WBC1wk:disappearHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL HEMOGLOBIN.HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALFunction transport oxygen.Constr
11、uctioniron-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 HOSPITALWBC CountsAt birth:20 x 109/LI
12、nfant: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.WBC RatioHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALPLT&Blood VolumePLT:150-250 x 109/LBlood Volume:Term newborn:85ml/kgPremature infant:95ml/kgAdult:75ml/kgYou
13、ng children:75-80ml/kgHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALThe Introduction of ANEMIAHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALDefinition 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 H
14、OSPITALAgeAnemiaValuesAnemiaDegreeNewborn145g/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,CHILDREN
15、S HOSPITALClassification-Etiology Reduced capacity to produce red blood cellsHemolysis Blood LossHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiology Reduced capacity to produce RBCAplastic anemiaFanconis anemiaAcquired aplastic anemiaPure red cell aplasiacongenital hypoplastic anemia (Diam
16、ond-Blackfan)Acquired hypoplastic anemiaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiologyReduced capacity to produce RBCMarrow InfiltrationLeukemiaLymphomaNeuroblastomLCHHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiology Reduced capacity to produce RBCDeficiency SyndromeIron F
17、olateVitamin B12Vitamin EVitamin B6HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiologyHemolysisIintrinsic RBC abnormalitiesHemoglobinopathiesEnzymopathiesMembrane disordersextrinsic RBC abnormalitiesImmunologic:AIHAHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiologyHemolysis:intr
18、insic RBC abnormalitiesIntrinsic membrane defectsHereditary Spherocytosis:HemoglobinopathyThalassemiaRBC enzyme defectsG6PD defectHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiologyHemolysis:extrinsic RBC abnormalitiesImmunologic hemolysis Isoimmune(Rh,ABO in neonate)Autoimmune Hemolytic A
19、nemia(AIHA)HEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALClassification-etiologyBlood lossGastrointestinal bleeding AnkylostomiasisMenstrualTraumaHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHematopoiesis Related TermsCFU-GMcolony forming
20、units granulocyte-macrophagesCFU-Megcolony-forming unite-megakaryocyteCFU-Ecolony-forming units-erythroidBFU-Eburst-forming units-erythroidG-CSFcolony-stimulating factorTPOthrombopoietinEPOerythropoietinRBC IndexMCVMeancorpuscularvolumeMCHMeancorpuscularhemoglobinMCHCMeancorpuscularconcertrationHEMA
21、TOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITALHEMATOLOGY/ONCOLOGY,CHILDRENS HOSPITAL此课件下载可自行编辑修改，仅供参考！此课件下载可自行编辑修改，仅供参考！感谢您的支持，我们努力做得更好！谢谢感谢您的支持，我们努力做得更好！谢谢