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1、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 parentsHematopoiesis:Hematopoiesis in fetus Hematopo
2、iesis after birthBlood features:RBC and Hb WBC PLT Blood volumeHematopoiesis in fetusDevelopmental HematopoiesisOccurs in three anatomic stages:mesoblastic(yolk sac)hepatic(liver)myeloid(marrow)SITESTIMEPRODUCMeasoblastichematopoisisYolkSac10-14thday3-4wk:primitiveblasts10-12wk:ceasedErythroidHepati
3、chematopoiesisLiverSpleen6-8wk:appear12-16wk:active6mo:diminish/stopatbirthErythroidM y e l o i dhematopoiesisBonemarrow4mo:start6mo:increase/steadyafterbirth:theonlyErythroidNeutrophilsMacrophagesFetal Hematopoiesis Development of Hematopoietic OrgansliverHematopoiesis after birth Myeloid hematopoi
4、esis Extramedullary hematopoiesisHematopoiesis 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 full of red marrow,no yellow marrow,no h
5、ematopoiesis 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 birth Bone marrow hematopoiesis Extramedullary hematopoiesis In infant,liver,spleen may be a hemat
6、opoiesis organ in response to certain severe hematologic stresses(hemolytic anemia,infection,etc),just like the fetus.It will return to the normal after treatment.RBC and Hb Level At Birth:RBC:5-7x1012/L Hb:150 to 220g/L.Postnatal fall/physiology anemia Infancy Preschool age:RBC:4 x 1012/L Hb:110 g/
7、L 7-12yr:adult level Physiological Anemia.nCauses:RBC production,RBC destruction,blood dilution nTime:23 monthnIn term infant:HB100g/L in preterm infan:HB 7090g/LRBC and Hb levelRBC and Hb level Reticulocytes At Birth:4%6%1-2mo:fall down to 0.3%Later adult level:0.5-1.5%Nucleated Red Blood Cells At
8、birth:3-10/100 WBC;10-20/100WBC 1wk:disappearWBC Counts At birth:20 x 109/L Infant:12 x 109/L Preschool:8.0 x 109/L(%)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 WBC Ratio PLT&Blood Volume PLT:150-250 x 109/L Blood Volume:Newborn:10%bodyweight Children:810%bodyweight adult:68%body
9、weightIt 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 parentsDefinition of Anemia A reduction of the red blood cell volume or hemoglobin concentration below the range of values.AgeAnemiaValuesAnemiaDegreeNewborn
10、145g/L1-4mo90g/LMild:-90g/L4-6mo100g/LModerate:-60g/L6mo-6yr110g/LSevere:-30g/L6-14yr120g/LExtremelysevere:94 32 32-38Normocromic/Normocytic 80-94 28-32 32-38Microcytic 80 28 32-28Hypochromic/Microcytic 80 28 32 Classification-morphologyClassification-morphology28RBC morphology and pathogeny形态分类形态分类
11、可能病因可能病因小细胞低色素性贫血缺铁性贫血，地中海贫血，铅中毒，慢性疾病（感染、炎症、恶性肿瘤、慢性肾病），维生素B6效应性贫血，铁粒幼细胞性贫血，铜缺乏性贫血，肺含铁血黄素沉着症，转铁蛋白缺乏症大细胞性贫血维生素B12缺乏，叶酸缺乏，骨髓增生异常综合征，肝疾病，甲状腺功能低下（部分），维生素B6缺乏（部分），维生素B1缺乏，乳清酸尿症，网织红细胞增多症，正常新生儿等正细胞性贫血生成减少：再生障碍性贫血，单纯红细胞再生障碍性贫血，骨髓浸润（白血病、恶性肿瘤、骨髓纤维化）；血液损失（早期）；溶血：红细胞酶缺乏所致溶血，红细胞膜缺陷所致溶血（部分），免疫性溶血，中毒，感染，微血管病性溶血（弥漫性
12、血管凝血、溶血尿毒综合症、高血压、心脏疾病）等。Manifestation of Anemia1、general manifestation pallor,weakness,undernutrition,growth retardation2、hepatosplenomegaly(except aplastic anemia)3、others:Manifestation of Anemia3、others:circulatory and respiratory system:tachypnea,shortness of breath on exertion,tachycardia,cardia
13、c dilatation,and congestive heart failture Manifestation of Anemia3、others:digestive system:poor appetite,diarrhea,nausea,vomitnervous system:lassitude,somnolence,dysphoria,impaired concentration,hypophreniaDiagnosis1、history:age sex native placecourse of disease and simultaneous phenomenondiet past
14、 medical historymedicine family history habitationDiagnosis2、physical examinationgrowing developmentnutritureskin and mucosanail and hairliver、spleen and lymph node Accessory examination1、blood routine examination2、red cell morphology3、reticulocyte count4、bone marrow examination5、analysis of hemoglobin6、fragility test7、special examinationTreatments1、etilogical treatment2、general treatment3、medication4、blood transfusion5、hematopoietic stem cell transplantation6、treatment of complication
