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Chapter 2
Cellular basis of hematopoiesis and marrow failure syndromes
Cellular basis of hematopoiesis
The hematopoietic system comprises a hierarchy of cell types with differing capacities for proliferation and differentiation (Figure 2-1). Although such a schema shows a sequential series of cellular compartments, in reality the system is a continuum of cell types with progressive restriction of self-renewal, proliferation, and differentiation potential. The most primitive stem cells are identified by their capacity to repopulate all lymphoid (T lymphocyte, B lymphocyte, natural killer), myeloid (granulocytic, monocytic), erythroid, and megakaryocytic cell lineages upon transplantation into lethally irradiated or immunocompromised hosts. Repopulating stem cells cycle slowly and exhibit potential for self-renewal, thereby maintaining the stem Hematopoietic stem cell concepts Pluripotency and self-renewal Defining the stem cell assay PHSCs are quiescent cells The leukemic stem cell Hematopoietic stem cell regulation: stochastic and deterministic models Stem cell plasticity Multipotent bone marrow stromal cells In search of the human hematopoietic stem cell Evidence of the existence of human PHSCs Long-term bone marrow culture Bone marrow microenvironment The long-term culture-initiating cell Xenotransplant models Hematopoietic stem cell emergence in embryonic life Stem cell enrichment strategies Physical properties Biologic properties Immunophenotype Murine PHSC phenotype Human PHSC phenotype Sources of hematopoietic stem cells Peripheral blood mobilized stem cells Cord blood Ex vivo expansion of PHSCs Number of stem cells required for engraftment
Aplastic anemia
Definition Epidemiology, etiology, and pathogenesis Clinical presentation and diagnosis Therapy Spontaneous recovery Supportive care/transfusions/growth factors Transplantation Immunosuppressive therapy Therapy: conclusion
Fanconi anemia and other inherited bone marrow failure states
Epidemiology Pathobiology Clinical features and diagnosis of FA Treatment Dyskeratosis congenita Clinical features Pathobiology Treatment Shwachman–Diamond syndrome Clinical features Pathobiology Treatment Congenital amegakaryocytic thrombocytopenia Clinical features Pathobiology Treatment Diamond–Blackfan anemia Clinical features Pathobiology Treatment Congenital dyserythopoietic anemias Treatment | |||||||||||||||||||||||||||||||||||||||||||||||||||