Anemia in childhood (小儿贫血),To understand features of hematopoiesis and blood in children. To comprehend clinical features, diagnosis and therapy of anemia. To understand the definition, grade division and classification of anemia in children. To master etiology, pathogeny, diagnosis, therapy and prevention of nutritional iron deficiency anemia and nutritional megaloblastic anemia.,Disease of hematopoietic system,infantile anemia （1）nutritional iron deficiency anemia(IDA) （2）nutritional megaloblastic anemia Primary/immunity thrombocytopenia Purpura(ITP) Leukemia,haematogenesis of children,hematopoiesis -produced blood extramedullary before birth and postnatal mesoblast hepatic medullary 3-15w 6w-6ms 3ms,Embryo stage,Mesoblastic haematogenesis：3ws begin，8ws weaken, 12-15ws disappears。 liver：8ws begin，6months gradually weaken ,erythroblast、granular cell and megakaryocyte.,Embryo stage,3、spleen：12ws begin erythrocyte, granule , lymphocyte 4、Haematogenesis of lymphatic organ 1.thoracic gland:8ws 2.lymphatic nodes:11ws,Embryo stage,5、myelo-haematopoiesis：6mons Haematogenesis function emphasis，make various kinds of blood cells，unique hematogenic organ after birth.,Haematopoiesis postnatal,1、marrow： 2、extramedullary：when requirement of haemopoiesis increase，liver、spleen、lymphadenectasis，hepatomegaly and splenomegaly, in circulating blood immature erythrocytes and granulocytes .,Physiological haemolysis,Normal newborns have higher hemoglobin(HB) and hematocrit levels and a shortened survival period of the fetal RBCs contributes to the development of physiologic anemia.,Physiological haemolysis,erythropoiesis abruptly ceases with onset of respiration at birth, when the arterial oxygen saturation rises toward 95%. levels of erythropoietin (EPO) are low. EPO has a decreased half-life and an increased volume of distribution in newborns. A shortened survival of the fetal RBC also contributes to the development of physiologic anemia. the sizable expansion of blood volume that accompanies rapid weight gain during the first 3 mo of life adds to the need for increased RBC production.,blood characteristics ages,red blood cells(RBC) and Hb Physiological haemolysis and anemia write blood cells(WBC) and classification 4-6 cross Platelets 150-250109/L blood volume 8-10%,Red blood cell (RBC),Term newborns have a red cell mass that is higher than at any other time of life. an appropriate condition for the low oxygen environment of intrauterine life. The RBC count is 5.010127.01012, hemoglobin concentration is about 150220g/L at birth. The RBC and hemoglobin concentration in preterm infants are slightly lower than those in term infants.,Red blood cell (RBC),The wide range of hemoglobin concentration is accounted for by: Variation in how rapidly the umbilical cord is clamped. An infants position after delivery. If cord clamping is delayed and the baby is held lower than placenta, both hemoglobin and blood volume are increased by a placental transfusion.,Change of HB after birth,Reticulocyte,Reticulocyte,Reticulocyte is 0.04-0.06 in the first 3 days. Reticulocyte decreases to 0.005-0.015 after 4-7 days. Reticulocyte rises to 0.02-0.08 in 4-6 weeks. Reticulocyte is equal to an adults after 5 months.,White blood cell(WBC),The normal number of WBC is higher in infancy and early childhood than later in life. WBC count is 15109 20109 at birth. After 612 hours, it rise to 21109 28109 and then begins to decrease to 12109 by 1 week. WBC count maintains about 10109 at infant period and approach adults WBC count level by 8 years.,White blood cell(WBC),The change in WBC classification is the proportion between lymphocyte and granulocyte. Lymphocyte is about 30% and granulocyte is about 65% at birth, but the later lymphocyte contrary to neutrophile granulocyte decreases. The proportion between lymphocyte and granulocyte is equal at 46 days after birth,White blood cell(WBC),Lymphocyte is about 60% and granulocyte is about 35% subsequently . They are equal at 46 years. After 7 years white cell classification in infants is similar to that in adult.,4-6 Days,Granulocyte,Lymphocyte,4-6 years,Change of proportion in Lymphocyte and Granulocyte,Platelet count,Normal value for the platelet count are about 150250109/L and vary little with age.,Blood volume,Blood volume in infants is more than in adults. The newborns blood volume is 10% of his weight and about 300ml on average. A childs is about 8%10% of his weight.,Anemia,Defination : Anemia is defined as a reduction of the red blood cell volume or hemoglobin concentration below the range of values occurring in healthy persons. Anemia is an absolute decrease in hematocrit , hemoglobin concentration, or the RBC count. Anemia is not a diagnosis, but a sign of underlying disease.,The criteria of anemia,Anemia,1. Classification 1） degree : mild moderate severe Very severe 2） Morphology of RBC 3）Causes: lost blood , hemolyti