Blood system in children of different age groups

1. §§ Anatomical and physiological features of Anatomical and physiological features of
blood system in children of different age blood system in children of different age
groups. Major clinical - semiotic groups. Major clinical - semiotic
hematological syndromes (anemic, hematological syndromes (anemic,
hemolytic and other hemorrhagic) and hemolytic and other hemorrhagic) and
diseases of the blood system in childrendiseases of the blood system in children
§§ As.prof., PhD Bilak Volodimyr As.prof., PhD Bilak Volodimyr

2. RelevanceRelevance
§§ many of anemia in children is not well many of anemia in children is not well
recognized;recognized;
§§ pathogenetic links not well understood; pathogenetic links not well understood;
§§ some forms of anemia (severe some forms of anemia (severe
hemorrhagic, a number of hereditary and hemorrhagic, a number of hereditary and
acquired hemolytic anemia, burns, acquired hemolytic anemia, burns,
aplastic) is a direct threat to the life of the aplastic) is a direct threat to the life of the
child or the child related to the lag in child or the child related to the lag in
physical or even mental development.physical or even mental development.

3. Blood systemBlood system
§§ A concept that unites the blood and A concept that unites the blood and
blood destroieng organs and apparatus blood destroieng organs and apparatus
of neurohumoral regulation. During of neurohumoral regulation. During
ontogeny quantitative and qualitative ontogeny quantitative and qualitative
parameters characterizing the state of parameters characterizing the state of
the blood undergo significant changes.the blood undergo significant changes.

4. Hematopoiesis and bloodHematopoiesis and blood
forming organsforming organs
§§ This process of maturation and This process of maturation and
subsequent blood elements in the so-subsequent blood elements in the so-
called organs of blood (Tour A.F., 1963)called organs of blood (Tour A.F., 1963)

5. BloodBlood ((sanguissanguis))
§§ This internal environment with full This internal environment with full
morphological structure and various morphological structure and various
functions. Conventionally, it is divided functions. Conventionally, it is divided
into two parts: blood components (red into two parts: blood components (red
blood cells, white blood cells and blood cells, white blood cells and
platelets) intercellular substance - platelets) intercellular substance -
plasma, which consists of proteins plasma, which consists of proteins
albumin, globulins, fibrinogen, enzymes, albumin, globulins, fibrinogen, enzymes,
hormones and other humoral substanceshormones and other humoral substances

6. Embryogenesis of bloodEmbryogenesis of blood
systemsystem
§§ The process of blood formation in the The process of blood formation in the
embryonic period is consistent:embryonic period is consistent:
§§ 1) in the yolk sac;1) in the yolk sac;
§§ 2) the liver;2) the liver;
§§ 3) the spleen;3) the spleen;
§§ 4) the thymus;4) the thymus;
§§ 5) lymph nodes;5) lymph nodes;
§§ 6) bone marrow.6) bone marrow.

7. Three stages of embryonicThree stages of embryonic
hematopoiesishematopoiesis
§§ anhioblastoma (end of the 2 th - early 3rd anhioblastoma (end of the 2 th - early 3rd
week of fetal development); hepatic week of fetal development); hepatic
blood (4 - 5 weeks of fetal development); blood (4 - 5 weeks of fetal development);
bone - cerebral blood (for 2 - 3 months of bone - cerebral blood (for 2 - 3 months of
fetal development).fetal development).

8. The cells are formed inThe cells are formed in
mezoblastyc period:mezoblastyc period:
§§ mehaloblast (primary erythroblasts)mehaloblast (primary erythroblasts)
§§ mehalotsyt (primary erythrocytes) mehalotsyt (primary erythrocytes)
§§ granulocytes granulocytes
§§ secondary erythroblasts secondary erythroblasts
§§ secondary erythrocytes secondary erythrocytes

9. Hepatic periodHepatic period
§§ 4 - 5 weeks of fetal development yolk sac 4 - 5 weeks of fetal development yolk sac
atrophies and becomes the center of atrophies and becomes the center of
hematopoiesis liver. Endothelial capillaries of hematopoiesis liver. Endothelial capillaries of
liver formed mehaloblast cells, and from the liver formed mehaloblast cells, and from the
mesenchyme - primary blood cells that give mesenchyme - primary blood cells that give
rise to secondary erythroblasts, granulocytes rise to secondary erythroblasts, granulocytes
and megakaryocytes. Approximately by the 5 and megakaryocytes. Approximately by the 5
th month hepatic hematopoiesis gradually th month hepatic hematopoiesis gradually
reduced, spleen and lymph nodes are reduced, spleen and lymph nodes are
included in hematopoiesis.included in hematopoiesis.

10. §§ On the 10th week begins hematopoiesis in the On the 10th week begins hematopoiesis in the
thymus, with a lymphoid direction. Origin of thymus, with a lymphoid direction. Origin of
spleen occurs at the end of the 1 st month of spleen occurs at the end of the 1 st month of
embryogenesis, are formed all blood cells, and embryogenesis, are formed all blood cells, and
the formation of red blood cells and the formation of red blood cells and
granulocytes reaches a maximum at 5 th granulocytes reaches a maximum at 5 th
month. Most lymph nodes develop on 9 - 10 month. Most lymph nodes develop on 9 - 10
weeks of fetal development, they are weeks of fetal development, they are
immediately differentiated to erythrocytes, immediately differentiated to erythrocytes,
granulocytes and megakaryocytesgranulocytes and megakaryocytes

11. Medullary periodMedullary period
§§ Red bone marrow is laid for 2 - 3 months Red bone marrow is laid for 2 - 3 months
pregnant fetal development, and at the pregnant fetal development, and at the
end is the main organ of blood. In mature end is the main organ of blood. In mature
postnatal bone marrow cells arise by postnatal bone marrow cells arise by
differentiation mainly elements differentiation mainly elements
(normoblasts, myelocytes) that make up (normoblasts, myelocytes) that make up
a considerable part of the myelogram.a considerable part of the myelogram.

12. Scheme hematopoiesisScheme hematopoiesis
§§ Parent hematopoietic stem cell is that is Parent hematopoietic stem cell is that is
differentiated in two ways: myelo - and differentiated in two ways: myelo - and
lymphopoiesis. General cell - miyelopoes lymphopoiesis. General cell - miyelopoes
precursor gives rise to clones of cells precursor gives rise to clones of cells
containing three rows of differentiation: containing three rows of differentiation:
erythrocytes, megakaryocytes and erythrocytes, megakaryocytes and
granulocytes.granulocytes.

13. Scheme hematopoiesisScheme hematopoiesis

14. Erythrocyte series:Erythrocyte series:
§§ erythroblast;erythroblast;
§§ pronormotsyt; pronormotsyt;
§§ normotsyt basophilic normotsyt basophilic
§§ normotsyt polihromatofilic; normotsyt polihromatofilic;
§§ normotsyt oxyphilic; normotsyt oxyphilic;
§§ reticulocytes; reticulocytes;
§§ erythrocyte. erythrocyte.

15. Platelet numberPlatelet number
§§ mehakarioblast;mehakarioblast;
§§ promegakaryocytes; promegakaryocytes;
§§ megakaryocytes;megakaryocytes;
§§ platelet. platelet.

16. Lymphocytic seriesLymphocytic series
§§ Lymphoblast; Lymphoblast;
§§ prolimfocyt;prolimfocyt;
§§ lymphocyte; lymphocyte;
§§ monocyte.monocyte.

17. Granulocytic series:Granulocytic series:
§§ myeloblasts;myeloblasts;
§§ promiyelocytes; promiyelocytes;
§§ myelocytes; myelocytes;
§§ stab neutrophil; stab neutrophil;
§§ segmented neutrophils; segmented neutrophils;
§§ basophils; basophils;
§§ eosinophils eosinophils

18. Features hematopoiesis inFeatures hematopoiesis in
toddlerstoddlers
§§ hematopoiesis to 4 years is in the red bone hematopoiesis to 4 years is in the red bone
marrow of all types of bones;marrow of all types of bones;
§§ lability of hemopoietic system and light lability of hemopoietic system and light
appearance extramedullary hematopoiesis foci;appearance extramedullary hematopoiesis foci;
§§ myeloid or lymphoid appearance metaplasia myeloid or lymphoid appearance metaplasia
under the influence of exogenous and under the influence of exogenous and
endogenous factors;endogenous factors;
§§ high regenerative capacity; high regenerative capacity;
§§ rapid depletion of hemopoietic system. rapid depletion of hemopoietic system.

19. Functions of bloodFunctions of blood
§§ The main functions of blood include:The main functions of blood include:
§§ transport; transport;
§§ protection; protection;
§§ homeostatic; homeostatic;
§§ breathing; breathing;
§§ trophic trophic

20. Features full-termFeatures full-term
newborn baby bloodnewborn baby blood
§§ Neonatal period (from birth to 28 days) is Neonatal period (from birth to 28 days) is
characterized by an increased number of red characterized by an increased number of red
blood cells and hemoglobin (associated with blood cells and hemoglobin (associated with
hypoxia, which occurs in utero):hypoxia, which occurs in utero):
§§ - Hemoglobin - 180 - 210 g / l; starting from 2 - Hemoglobin - 180 - 210 g / l; starting from 2
th day of life hemoglobin decreased, reaching th day of life hemoglobin decreased, reaching
the end of the 1 st month of life 145 g / l;the end of the 1 st month of life 145 g / l;
§§ - Erythrocytes - 5-7 · 10¹² / l;- Erythrocytes - 5-7 · 10¹² / l;

21. §§ - - Reticulocytes - up to 5% may be normotsyty and Reticulocytes - up to 5% may be normotsyty and
normoblasts;normoblasts;
§§ - Leukocytes - 11 - 33 × 10 9 / L, 7 day this number - Leukocytes - 11 - 33 × 10 9 / L, 7 day this number
drops to 10 × 10 9 / L;drops to 10 × 10 9 / L;
§§ - 5 - 7 day - the first physiological crossroads - 5 - 7 day - the first physiological crossroads
lymphocytes is the number of segmented neutrophils lymphocytes is the number of segmented neutrophils
and an average of 40 - 45%;and an average of 40 - 45%;
§§ - Platelets - 140 - 400 × 10 9 / L (average 220 × 10 9 / - Platelets - 140 - 400 × 10 9 / L (average 220 × 10 9 /
L);L);
§§ - -speed erythrocyte sedimentation - 2-4 mm / h;- -speed erythrocyte sedimentation - 2-4 mm / h;
§§ - Hematocrit at 55%.- Hematocrit at 55%.

22. InfansyInfansy
§§ Mass of blood is 11% of body weight;Mass of blood is 11% of body weight;
§§ - Share - 1050 - 1060;- Share - 1050 - 1060;
§§ - Hemoglobin - 120 - 110 g / l;- Hemoglobin - 120 - 110 g / l;
§§ - Erythrocytes - 4 - 4,5 · 10'² / l;- Erythrocytes - 4 - 4,5 · 10'² / l;
§§ - Leukocytes - 10 - 12 × 10 9 / L;- Leukocytes - 10 - 12 × 10 9 / L;
§§ - Color index - 0.8 - 1.0;- Color index - 0.8 - 1.0;
§§ aged 5 - 6 months. - "Physiologicalaged 5 - 6 months. - "Physiological
§§ anemia " anemia "
§§ - Reticulocytes - 1%;- Reticulocytes - 1%;
§§ - Moderate monocytosis - 9-11%;- Moderate monocytosis - 9-11%;
§§ - Leukocytes - 8 -9 × 10 9 / L;- Leukocytes - 8 -9 × 10 9 / L;
§§ - Platelets - 250 - 350 × 10 9 / L;- Platelets - 250 - 350 × 10 9 / L;
§§ - Hematocrit - 42 - 35%.- Hematocrit - 42 - 35%.

23. todllerstodllers
§§ Hemoglobin - 125 - 130 g / l;Hemoglobin - 125 - 130 g / l;
§§ - Erythrocytes - 4.5 x 10 ¹² / l;- Erythrocytes - 4.5 x 10 ¹² / l;
§§ color index -color index -
§§ 0.8 - 1.0; 0.8 - 1.0;
§§ 5 -7 years - the second5 -7 years - the second
§§ physiological crosse physiological crosse
§§ (lymphocytes (lymphocytes
§§ equal to the number of neutrophils); equal to the number of neutrophils);
§§ after 7 years - blood in adults;after 7 years - blood in adults;

24. The main syndromes ofThe main syndromes of
blood Systemblood System
§§ anemic; anemic;
§§ hemorrhagic;hemorrhagic;
§§ leukemoid reaction. leukemoid reaction.

25. Causes of anemiaCauses of anemia
syndromesyndrome
§§ blood lossblood loss
§§ violation of erythrocytes and violation of erythrocytes and
hemoglobinhemoglobin
§§ increasing destruction of red blood cells increasing destruction of red blood cells
§§ hematopoietic factors deficiency (iron, hematopoietic factors deficiency (iron,
protein, folate, vitamin B 12).protein, folate, vitamin B 12).

28. Anemia syndromeAnemia syndrome

29. Types of bleeding duringTypes of bleeding during
hemorrhagic syndromehemorrhagic syndrome
§§ hematom hematom
§§ petechial - spotted petechial - spotted
§§ vaskular – purplevaskular – purple
§§ microanhiomatoz microanhiomatoz
§§ mixed mixed

30. Hematom type of bleedingHematom type of bleeding

31. thrombocytopenic purpurathrombocytopenic purpura

32. Vaskule-purple type ofVaskule-purple type of
bleedingbleeding

33. Mixed bleeding (illnessMixed bleeding (illness
Villebrandt)Villebrandt)

34. Imunoblast lymphadenitisImunoblast lymphadenitis
§§ blast transformed B cells (immunoblasts) blast transformed B cells (immunoblasts)
in the center of the follicles is increasing in the center of the follicles is increasing
the total lymph node; adeno- and the total lymph node; adeno- and
enterovirus infection, infectious enterovirus infection, infectious
mononucleosis, a disease "cat scratches" mononucleosis, a disease "cat scratches"
drug allergic dermatitis, kollagenozes, drug allergic dermatitis, kollagenozes,
vaccination lymphadenitisvaccination lymphadenitis

37. Complaints of patientsComplaints of patients
with damage to the bloodwith damage to the blood
systemsystem
§§ drowsiness, pallor, increased fatigue, drowsiness, pallor, increased fatigue,
headache, dizziness, loss of appetite, headache, dizziness, loss of appetite,
irritability;irritability;
§§ frequent bleeding; frequent bleeding;
§§ arthralgia; arthralgia;
§§ feeling of heaviness and pain in the abdomen; feeling of heaviness and pain in the abdomen;
§§ increasing t ° body; increasing t ° body;
§§ distortion of taste distortion of taste

38. History in the pathology ofHistory in the pathology of
the blood systemthe blood system
§§ genetic history;genetic history;
§§ adverse pregnancy, childbirth; adverse pregnancy, childbirth;
§§ disease in infancy; disease in infancy;
§§ pathology of the alimentary canal; pathology of the alimentary canal;
§§ abuse care, feeding, abuse care, feeding,
§§ unfavorable sanitary - hygienic unfavorable sanitary - hygienic
conditions.conditions.

39. Features of changes inFeatures of changes in
surveysurvey
§§ discoloration of the skin, the appearance discoloration of the skin, the appearance
of hemorrhage;of hemorrhage;
§§ swollen lymph nodes, liver, spleen, swollen lymph nodes, liver, spleen,
§§ increase in joints (hemarthrosis), increase in joints (hemarthrosis),
abdomen, swelling,abdomen, swelling,
§§ severe malformations. severe malformations.

41. Groups of lymph nodesGroups of lymph nodes
§§ occipital;occipital;
§§ submandibular; submandibular;
§§ anterior - and posterior neck; anterior - and posterior neck;
§§ over-and subclavian; over-and subclavian;
§§ aksilyar; aksilyar;
§§ thoracic;thoracic;
§§ elbow; elbow;
§§ inguinal; inguinal;
§§ popliteal.popliteal.

42. Study of blood include:Study of blood include:
§§ study of peripheral blood (finger, earlobe, a study of peripheral blood (finger, earlobe, a
newborn heel);newborn heel);
§§ vivo study using bone marrow - is bone vivo study using bone marrow - is bone
marrow puncture; marrow puncture;
§§ in ukraine - a puncture of the sternum, often in ukraine - a puncture of the sternum, often
abroad puncture of iliac bone or puncture of abroad puncture of iliac bone or puncture of
external appendix tibia by the needle external appendix tibia by the needle
KasirskogoKasirskogo

43. percussionpercussion
§§ bones and sternum (pain)bones and sternum (pain)
§§ chest (mediastinal enlarged lymph chest (mediastinal enlarged lymph
nodes)nodes)
§§ stomach (enlarged liver and spleen)stomach (enlarged liver and spleen)

44. Bone marrow punctureBone marrow puncture
§§ value elements of white and red blood value elements of white and red blood
cells is continuous in - 3: 1;cells is continuous in - 3: 1;
§§ number of granulocytes - 40 - 60%;number of granulocytes - 40 - 60%;
§§ lymphocytes and cells of the RES - 10 - lymphocytes and cells of the RES - 10 -
20%;20%;
§§ monocytes - less than 3 - 5%;monocytes - less than 3 - 5%;
§§ megakaryocytes - 0.5% of all elements.megakaryocytes - 0.5% of all elements.

45. General rules for bloodGeneral rules for blood
collectioncollection
§§ at the same time of day, preferably in the at the same time of day, preferably in the
morning;morning;
§§ on an empty stomach or one hour after a on an empty stomach or one hour after a
light breakfast;light breakfast;
§§ before conducting any medical procedures; before conducting any medical procedures;
§§ calm state of the child; calm state of the child;
§§ before morning exercises or other physical before morning exercises or other physical
activitiesactivities

46. Thank youThank you