Development of the Hematopoietic System

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Development of the Hematopoietic System Blood
Cell Counts

• Dr.Jie Yu, MD. Professor
• The department of Pediatric, Hematology/Oncology

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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

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Development of Hematopoietic System
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• In the embryo and fetus,
• constant changes characterize
• all phases of hematopoiesis.

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Development of Hematopoietic Organs

• Fetal hematopoiesis
• Mesoblastic Hematopoiesis
• Hepatic Hematopoiesis
• Myeloid Hematopoiesis
• Hematopoiesis after birth

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Development of Hematopoietic Organs
Fetal Hematopoiesis
liver
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Table 1. Fetal Hematopoiesis
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Development of Hematopoietic Organs

• Fetal hematopoiesis
• Hematopoiesis after birth
• Bone marrow hematopoiesis
• Extrmedullary hematopoiesis

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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

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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).

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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

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Table 2.The Development of Blood Cells
PROGENITOR CYTOKINES PRODUC
CFU-GM G-CSF NUTROPHIL
CFU-Meg TPO PLT
CFU-E BFU-E EPO RBC
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Fig1.Hematopoisis
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Blood Cell Counts and Hemoglobin
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Fig2. Peripheral Blood Cells
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RBC and Hb Level

• At Birth
• RBC 5-7x1012/L
• Hb150 to 230g/L.
• Postnatal fall /physiology anemia
• Infancy ? Preschool age
• RBC 4 x 1012/L
• Hb 110 g/L
• 7-12yr adult level

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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

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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

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HEMOGLOBIN.

• Function
• transport oxygen.
• Construction
• iron-containing heme plus globins which is a
  tetramer made up of two pairs of polypeptide
  chains,

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Table3. HEMOGLOBINS
gt95
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WBC Counts

• At birth 20 x 109/L
• Infant 12 x 109/L
• Preschool 8.0 x 109/L

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Fig4. WBC Ratio
                 
 
()70
????
60   50   40   30   20   10
4-6?
4-6?
?????
1 3 5 7 9   ??
1 3 5 7 9 11   ??
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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

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The Introduction of ANEMIA
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Definition of Anemia

• A reduction of the red blood cell volume or
  hemoglobin concentration below the range of
  values occurring in healthy persons

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Table 4. The definition of Anemia and Degree
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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
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Fig5The oxygen dissociation curve
Self study
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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
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Classification-morphology
Table 5
  MCV(fl) MCH(pg) MCHC()
Normal ranges 80-94 28-32 32-38
Macrocytic gt94 gt32 32-38
Normocromic /Normocytic 80-94 28-32 32-38
Microcytic lt80 lt28 32-28
Hypochromic /Microcytic lt80 lt28 lt 32
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Classification- Etiology

• Reduced capacity to produce red blood cells
• Hemolysis
• Blood Loss

THANK YOU
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Classification- etiology

• Reduced capacity to produce RBC
• Aplastic anemia
• Fanconis anemia
• Acquired aplastic anemia
• Pure red cell aplasia
• congenital hypoplastic anemia
• (Diamond-Blackfan)
• Acquired hypoplastic anemia

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Classification- etiology

• Reduced capacity to produce RBC
• Marrow Infiltration
• Leukemia
• Lymphoma
• Neuroblastom
• LCH

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Classification-etiology

• Reduced capacity to produce RBC
• Deficiency Syndrome
• Iron
• Folate
• Vitamin B12
• Vitamin E
• Vitamin B6

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Classification-etiology

• Hemolysis
• Iintrinsic RBC abnormalities
• Hemoglobinopathies
• Enzymopathies
• Membrane disorders
• extrinsic RBC abnormalities
• Immunologic AIHA

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Classification-etiology

• Hemolysisintrinsic RBC abnormalities
• Intrinsic membrane defects
• Hereditary Spherocytosis
• Hemoglobinopathy
• Thalassemia
• RBC enzyme defects
• G6PD defect

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Classification-etiology

• Hemolysisextrinsic RBC abnormalities
• Immunologic hemolysis
• Isoimmune (Rh, ABO in neonate)
• Autoimmune Hemolytic Anemia (AIHA)

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Classification-etiology

• Blood loss
• Gastrointestinal bleeding
• Ankylostomiasis
• Menstrual
• Trauma

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Mount Raniner, Seattle
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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

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RBC Index

• MCV
• Mean corpuscular volume
• MCH
• Mean corpuscular hemoglobin
• MCHC
• Mean corpuscular concertration

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