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Development of the Hematopoietic System & Blood Cell Counts

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

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Development of the Hematopoietic System & Blood Cell Counts

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

  2. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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

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

  4. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

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

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

  7. Development of Hematopoietic Organs Fetal Hematopoiesis liver

  8. 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 HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Table 1. Fetal Hematopoiesis

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

  10. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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

  11. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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).

  12. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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

  13. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Table 2.The Development of Blood Cells

  14. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Fig1.Hematopoisis

  15. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

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

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

  18. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL RBC 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

  19. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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

  20. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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

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

  22. Hb Chains 8周 6月 出生 6-12月 2岁 Embry Gower1 ζ2ε2 8周前， 3月消失 Gower2 α2ε2 Portlan ζ2γ2 Fetal HbF α2γ2 增加 90% 70% <5% <2% Adult HbA α2β2 5-10% 30% >95% HbA2 α2δ2 <1% 2-3% <3.5% HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Table3. HEMOGLOBINS >95%

  23. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL WBC Counts • At birth: 20 x 109/L • Infant: 12 x 109/L • Preschool: 8.0 x 109/L

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

  25. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL PLT & 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

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

  27. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Definition of Anemia • A reduction of the red blood cell volume or hemoglobin concentration below the range of values occurring in healthy persons

  28. Age Anemia Values Anemia Degree Newborn < 145g/L 1-4 mo < 90g/L Mild: -90g/L 4-6 mo < 100g/L Moderate: -60g/L 6 mo-6 yr < 110g/L Severe: -30g/L 6-14 yr < 120g/L Extremelysevere:<30g/L HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Table 4. The definition of Anemia and Degree

  29. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Pathophysiology of Anemia • 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. Self study

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

  31. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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 Self study

  32. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Classification-morphology Table 5

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

  34. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL 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

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

  36. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Classification-etiology • Reduced capacity to produce RBC • Deficiency Syndrome • Iron • Folate • Vitamin B12 • Vitamin E • Vitamin B6

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

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

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

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

  41. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Mount Raniner, Seattle

  42. 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 HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL Hematopoiesis Related Terms

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

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  45. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

  46. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

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  50. HEMATOLOGY/ONCOLOGY, CHILDREN’S HOSPITAL

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