小儿造血和血液特点(英文)VIP免费

DevelopmentoftheHematopoieticSystem&BloodCellCountsDr.JieYu,MD.ProfessorThedepartmentofPediatric,Hematology/OncologyHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALContentsDevelopmentofhematopoieticsystemHematopoieticorgansHematopoieticbloodcellsCharacteristicofcellcountsandhemoglobinRBCandHblevelHemoglobinWBC/Platelet/BloodvolumeAnemiaHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentofHematopoieticSystemHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALIntheembryoandfetus,constantchangescharacterizeallphasesofhematopoiesis.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentofHematopoieticOrgans•Fetalhematopoiesis–MesoblasticHematopoiesis–HepaticHematopoiesis–MyeloidHematopoiesis•HematopoiesisafterbirthHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentofHematopoieticOrgansFetalHematopoiesisliverSITESTIMEPRODUCMeasoblastichematopoisisYolkSac10-14thday3-4wk:primitiveblasts10-12wk:ceasedErythroidHepatichematopoiesisLiverSpleen6-8wk:appear12-16wk:active6mo:diminish/stopatbirthErythroidMyeloidhematopoiesisBonemarrow4mo:start6mo:increase/steadyafterbirth:theonlyErythroidNeutrophilsMacrophagesTable1.FetalHematopoiesisHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentofHematopoieticOrgans•Fetalhematopoiesis•Hematopoiesisafterbirth–Bonemarrowhematopoiesis–ExtrmedullaryhematopoiesisHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentofHematopoieticOrgans•Hematopoiesisafterbirth–Bonemarrowhematopoiesis•Allbloodcellsareproducedinthemarrowafter2ndtrimester•Newbornandearlyinfancy:redmarrow•5-7yr:yellowmarrow–ExtramedullaryhematopoiesisHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentofHematopoieticOrgans•Hematopoiesisafterbirth–Bonemarrowhematopoiesis–Extramedullaryhematopoiesis•Indiseasesstatus:redcellproductionhematopoietictissue.•bloodproductionexpandstoreplacefattymarrow.•bloodcellsproductionextendstoextramedullarysites(liverandspleen).HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALDevelopmentoftheHematopoieticBloodCells•PluripotentStemCells:–whicharecapableofbothself-renewalandofclonalmaturationintoallbloodcelllineages.–ProgenitorcellsdifferentiateundertheinfluenceofhematopoieticgrowthfactorsHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALTable2.TheDevelopmentofBloodCellsPROGENITORCYTOKINESPRODUCCFU-GMG-CSFNUTROPHILCFU-MegTPOPLTCFU-EBFU-EEPORBCHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALFig1.HematopoisisHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALBloodCellCountsandHemoglobinHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALFig2.PeripheralBloodCellsHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALRBCandHbLevel•AtBirth:–RBC:5-7x1012/L–Hb:150to230g/L.•Postnatalfall/physiologyanemia•InfancyPreschoolage:–RBC:4x1012/L–Hb:110g/L•7-12yr:adultlevelHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALRBCandHblevel•PhysiologicalAnemia.–Hemoglobinvaluesinterminfantsdroptotheirlowestmeanof100g/Lat2-3mo–Causes•Erythropoietinproduction•Redcelllifespan(90/120)•Bloodvolume–PreterminfantHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALRBCandHblevel•Reticulocytes–AtBirth:5%/10%–1-2mo:falldownto0.3%–Lateradultlevel:0.5-1.5%•NucleatedRedBloodCells–Atbirth:3-10/100WBC;10-20/100WBC–1wk:disappearHEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITALHEMOGLOBIN.HEMATOLOGY/ONCOLOGY,CHILDREN’SHOSPITAL•Function–transportoxygen.•Construction–iron-containinghemep...