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1、Introduction of Hematopoietic System,Purpose and demand:,To grasp the child hematopoiesis characteristic and hemogram characteristic.To understand the definition and category of child anemia.,2 months girl,Hb 100g/L,normal?One year old boy,WBC 10109/L,N60%,L40%,normal?,The question from parents,Hema
2、topoiesis:Hematopoiesis in fetusHematopoiesis after birthBlood features:RBC and HbWBCPLTBlood volume,Hematopoiesis in fetus,Developmental HematopoiesisOccurs in three anatomic stages:mesoblastic(yolk sac)hepatic(liver)myeloid(marrow),Fetal Hematopoiesis,Development of Hematopoietic Organs,liver,Hema
3、topoiesis after birthMyeloid hematopoiesisExtramedullary hematopoiesis,Hematopoiesis after birthMyeloid hematopoiesisActive hematopoietic tissue(red marrow)Fatty tissue(yellow marrow),The yellow marrow can change to red marrow in response to certain severse hematologic stresses.,Infant:all bone was
4、full of red marrow,no yellow marrow,no hematopoiesis storeYoung children:more red marrow,less yellow marrow,a little hematopoiesis store Older children and adult:less red marrow,more yellow marrow,more hematopoiesis store,Hematopoiesis after birthBone marrow hematopoiesisExtramedullary hematopoiesis
5、 In infant,liver,spleen may be a hematopoiesis organ in response to certain severe hematologic stresses(hemolytic anemia,infection,etc),just like the fetus.,It will return to the normal after treatment.,Blood Cell Counts and Hemoglobin,RBC and Hb Level,At Birth:RBC:5-7x1012/L Hb:150 to 220g/L.Postna
6、tal fall/physiology anemiaInfancy Preschool age:RBC:4 x 1012/L Hb:110 g/L 7-12yr:adult level,Physiological Anemia.Causes:RBC production,RBC destruction,blood dilution Time:23 monthIn term infant:HB100g/L in preterm infan:HB 7090g/L,RBC and Hb level,RBC and Hb level,ReticulocytesAt Birth:4%6%1-2mo:fa
7、ll down to 0.3%Later adult level:0.5-1.5%Nucleated Red Blood CellsAt birth:3-10/100 WBC;10-20/100WBC1wk:disappear,WBC Counts,At birth:20 x 109/LInfant:12 x 109/LPreschool:8.0 x 109/L,(%)70,淋巴细胞,中性粒细胞,4-6岁,4-6天,605040302010,1 3 5 7 9 日数,1 3 5 7 9 11 岁数,WBC Ratio,PLT&Blood Volume,PLT:150-250 x 109/LBl
8、ood Volume:Newborn:10%bodyweightChildren:810%bodyweightadult:68%bodyweight,It is easy to get dehydration in children.,2 months girl,Hb 100g/L,normal?One year old boy,WBC 10109/L,N60%,L40%,normal?,The question from parents,Anemia in children,Definition of Anemia,A reduction of the red blood cell volu
9、me or hemoglobin concentration below the range of values.,The definition of Anemia and Degree,Classification-Etiology,Reduced capacity to produce RBCHemolysisBlood loss,Reduced capacity to produce RBC,Deficiency of hemopoietic factorsBone marrow failtureDeficiency of EPOOthers,Classification-Etiolog
10、y,HemolysisIntrinsic RBC abnormalitiesIntrinsic membrane defect:hereditary spherocytosisRBC enzyme defect:G6PD defectHemoglobinopathy:thalassmiaExtrinsic RBC abnormalitiesImmunologic factorsInfectious factorsPhysical and chemical factorsOthers.,Classification-Etiology,Blood lossGastrointestinal blee
11、ding AnkylostomiasisMenstrual Trauma,Classification-morphology,28,RBC morphology and pathogeny,Manifestation of Anemia,1、general manifestation pallor,weakness,undernutrition,growth retardation2、hepatosplenomegaly(except aplastic anemia)3、others:,Manifestation of Anemia,3、others:circulatory and respi
12、ratory system:tachypnea,shortness of breath on exertion,tachycardia,cardiac dilatation,and congestive heart failture,Manifestation of Anemia,3、others:digestive system:poor appetite,diarrhea,nausea,vomitnervous system:lassitude,somnolence,dysphoria,impaired concentration,hypophrenia,Diagnosis,1、histo
13、ry:age sex native placecourse of disease and simultaneous phenomenondiet past medical historymedicine family history habitation,Diagnosis,2、physical examinationgrowing developmentnutritureskin and mucosanail and hairliver、spleen and lymph node,Accessory examination,1、blood routine examination2、red cell morphology3、reticulocyte count4、bone marrow examination5、analysis of hemoglobin6、fragility test7、special examination,Treatments,1、etilogical treatment2、general treatment3、medication4、blood transfusion5、hematopoietic stem cell transplantation6、treatment of complication,
