ANATOMIC-AND-PHYSIOLOGICAL FEATURES OF BLOOD SYSTEM IN CHILDREN. SEMIOTICS OF BLOOD DISEASES IN CHILDREN.

Lecture N 10

Red blood

Hemoglobin in newborns is 180-240 g/l, on the average 210.

Number of Erythrocytes 5-7 Т/l. Color index is 1-1.3. There are anisocytosis (the different sizes of cells),

poikilocytosis (the different form), polychromatophilia (different ability to coloration), and macrocytosis.

The number of reticulocytes makes 2-5 % (in adults 0.6-0.8 %).

From 3 to 6 months the physiological anemia takes a place, hemoglobin level is 110 – 120 g/l, erythrocytes 3.5-4 Т/l, color index 0.8-1. Hemoglobin in children till 5 years old is not lower then 110, after 5 years – not lower then 120.

ESR in neonate is 0-2 mm / hour, on the first year-2-4 mm, after one year - 6-12 mm.

White blood

The content of leucocytes in newborns 18-20 G/l, in 2 weeks 10-12 G/l, by the end of year 8-10 G/l, then 4-9 G/l.

The leukocyte count. There are in norm during whole life: eosinophiles no more than 5 %,

basophiles – 0 - 1 %, monocytes 6-10 %. The count of neutrophils and lymphocytes depend on age of the

child. In neonate neutrophils count is approximately 60 %, lymphocytes count is about 30 %, then quantity of neutrophils decreases, and the quantity of lymphocytes increases.

In 5 day the first physiological lymphocytes-and-neutrophils decussation, the contents of both neutrophils and lymphocytes become about 45 %.

From 5 days till 5 years in children the physiological lymphocytosis, i.e. the contents of lymphocytes is about 60 %, and neutrophils – about 30 %

In 5 years the second decussation of lymphocytes and neutrophils, their counts are about 45 %. After 5 years the number of neutrophils and lymphocytes equal their number in adult, i.e. 60 and 30% accordingly.

Neutrophils

Neutrophils in a peripheric blood can be submitted with juvenile, stab and segmented cells. The first 2 kinds of cells are immature, last kind – mature forms.

The content of young form of neutrophils in norm is no more then 7 %.

More then 7% of immature forms speaks about shift of the differential count to the left, sometimes down to myelocytes. Newborns have a physiological shift to the left.

Presence of blast forms in a peripheric blood is characteristic of a leucosis.

Coagulation

The content of thrombocytes in any age in norm is 180 - 400 G/л.

Bleeding time makes in norm is 2-4 minutes

Blood clotting time is 6-10 minutes 

Complaints

Characteristic signs at anemia are fatigability, irritability, changes of taste and smell sensation, pallor or jaundice.

Hemorrhagic diathesis is characteristic by bleeding and hemorrhagic exanthema.

Hyperplasia of lymph nodes, expansion of abdomen, pain or feeling of gravity in right or left hypochondria, augmentation of liver and spleen can be observed.

Groups of lymph nodes

Occipital - in the field of an occipital bone Parotic - on a mastoid and ahead of a tragus Submandibular Anterior and posterior cervical – on forward and

back edge of sternocleidomastoid Supraclavicular and subclavicular Thoracic – on the lower edge of pectoral major

muscle Axillary Cubital – in a sulcus of biceps Inguinal Popliteal

Lymphadenopathia

Lymph nodes in norm can be palpated no more, than in 3 groups (usually submandibular, anterior cervical and inguinal lymph nodes).

In each group can palpated no more than 3 lymph nodes smaller 1 sm.

In norm lymph nodes are elastic, mobile, painless and the soft tissues above them are not changed.

The change of quantity, the sizes and properties of lymph nodes testifies about pathology. Pathological lymph nodes are dense, painful, and no mobile.

Augmentation of lymph nodes augmentation of lymph nodes can be local

and generalized generalized augmentation of lymph nodes

can be observed in disseminated tuberculosis, chronic tubercular intoxication, toxoplasmosis, infectious - allergic diseases, diseases of blood, tumors.

In anomalies of constitution – in allergic, lymphatic-hypoplastic diathesis (+hyperplasic of thymus).

Anemia

Paleness of a skin and mucous is observed, the giddiness, expansion of borders of heart, systolic apex murmur are possible.

In a blood the level of hemoglobin is lower then 110 in children till 5 years and lower then 120 in children after 5 years old, and also quantity of erythrocytes is lower then 3.5 Т/l.

The anysocytosis, poikilocytosis are observed. Anemia of the 1st stage – a level of hemoglobin 110

(120) - 90, 2nd – 90 - 70, 3rd – lower than 70 g/l. Depending on color index the anemia can be

hypochromic, normocromic, hyperchromic. Anemia can be deficient (iron-deficient, vitamin-

deficient (vitamin В-12, folic acid), protein-deficient), posthemorrhagic, hemolytic, aplastic.

Anemia

Iron deficient anemia in children of early age is caused by the nutritional factor, in teenagers – by the latent hemorrhages and deficiency of iron in nutrition. The changing of smell and test sensation is typical of an iron deficient anemia. Children like smell of petrol, acetone, varnish. They can like to eat the chalk. Iron deficient anemia is always hypochromic. Serum iron is lower then 20 mkmol/l.

B12-deficient anemia is hyperchromic, macrocytic. Such anemia can be caused by infringement of an adsorption of vitamin В12 at an autoimmune chronic gastritis or more often by the nutritional factor (feeding by goat’s milk).

Posthemorrhagic anemia. In acute bleeding main symptoms are weakness, cold sweat, fever, arterial hypotension, dyspnea, tachycardia, thread pulse. Then all symptoms of an iron deficient anemia develop.

Anemia

Hemolytic anemia can be hereditary and acquired, as a rule, hypochromic. In a basis of hereditary hemolytic anemia defect of membrane of erythrocytes (microspheric anemia), infringement of structure and synthesis of hemoglobin (thalassemia) lays.

The acquired hemolytic anemia may have an immune parentage (newborn hemolytic disease, an incompatible blood transfusion), infectious (malaria), toxic (arsenic, lead poisons bee’s, snake’s, mushroom venom).

In hemolytic anemia there is jaundice, augmentation of spleen and liver, indirect hyperbilirubinemia, downstroke of osmotic resistance of erythrocytes.

Aplastic anemia also can be hereditary ( Fanconi’s aplastic anemia) and acquired (influence of radiation, antibiotics, Sulfanilamide, aspirin and other medicines).

Hemorrhagic symptoms

The hemorrhagic symptoms (bleeding disorders) arises in pathology of any of 3 parts of hemostasis – capillar, platelet, blood coagulation.

Pathology of capillar link of hemostasis is observed in hemorrhagic vasculitis (Schenlein –Genoch’s purpura, allergic purpura). On symmetric sites of body, more often on rebending surfaces of extremities around of joints appear hemorrhagic eruption of dark red color with predilection to necrosis in center and formation of crusts. Besides papules, vesicles and urticar eruption are observed.

In thrombocytopenia, for example, in Werlhoff’s disease, there is a plenty of petechias and ecchymomas on a skin, which gradually change a color, nasal, uterine, gum bleedings are observed.

At coagulopathy (Hemophilia) hemorrhages into the skin, hypodermic fat, joints, ant also profuse posttraumatic bleedings are observed.

Leucosis

signs of intoxication symptoms of anemia hemorrhagic symptoms augmentation of lymph nodes, liver, spleen osteoporosis changes of cardiovascular system –expansion of

borders of heart, systolic murmur changes of nervous system – neuroleucosis hematological changes – presents in a peripheric

blood unripe (blast) forms of leucocytes, anemia, thrombocytopenia, raised ESR

in a myelogram proliferation of blast cells, 50 and more %, and also pathologicfal trombocyte- and erythropoesis

Leucosis

Acute leucosis - absence in a peripheric blood of intermediate forms of leucocytes (a leukemic failure) – only blasts and segmented neutrophils

Chronic leucosis - presence of intermediate forms (absence of a leukemic failure)

Distinguish lymphoblactic and mieloblastic leucosis.

In 80 % cases - acute lymphoblastic leucosis.

Lymphogranulomatosis

tumor disease of lymphatic tissue. lymph nodes make large conglomerates,

they are dense, painless and palpated like potato in a bag; skin above them is thin; with dilated venous network.

In a blood leukocytosis, neutrophilia with shift to left, lymphopenia, encreased ESR