An Introduction to

Haematopoiesis
Prof Vernon Louw
Clinical Haematology
University of Cape
Town
Haematopoiesis = the process by
which blood cells are formed in
the factory of blood
From Greek haimato-, combining haima (blood) and poiein (to make, create).
Factory of blood

→ Fetus
→ Yolk sac
→ Liver
→ Spleen
→ Bone marrow (in late
foetal life)

→ Adult
→ Bone marrow
Production

→ Carefully regulated process to ensure adequate

numbers of each type of blood cell:
→ White blood cells
→ Red blood cells
→ Platelets

→ Under- or overproduction usually indicates a

pathological process
Production

→ The Full Blood Count (FBC) is

a very useful (and the most
commonly ordered) blood test
that will provide clues to
many possible underlying
disease processes.
Step-wise process

→ Blood cells produced in a stepwise

development process from
immature precursor cells to mature
cells with specific functions

→ Mature cells leave the factory and

enter the blood stream. Some can
enter tissues to do their work.

→ The most immature precursor cell

that gives rise to the production of
blood cells is called the
haematopoietic stem cell.
 Protection system

Backup system Production system

Stem cell niches

→ Stem cells develop in niches

→ Need healthy microenvironment to thrive

No need to know details – picture for interest only

Haematopoiesis
Stem cells
1:10000 BM cells

500 Billion cells per day

http://focosi.altervista.org
Proliferation
→ “One becomes many” Few

→ Proliferation and anti-apoptotic signals

→ Acceleration and brake

Many
Differentiation = maturation

Immature
→ Cells change into different cells with different
functions

Mature
Differentiation = maturation

→ Cells change into different cells with different

functions

-blasts

-cytes
-phils
Differentiation = maturation

No adult fx
→ Cells change into different cells with different
functions

Function
Functions of blood cells

Blood / Circulation
Stem cells

Mature
Red blood Oxygen transport
cells
Mature
White blood Infection control
cells
Mature
Platelets Coagulation
Erythropoiesis

http://focosi.altervista.org
ERYTHROPOIESIS

→ Erythropoiesis (from Greek 'erythro' meaning "red" and 'poiesis'

meaning "to make") refers to the production of red blood cells

→ About 120 million RBCs produced per second in the bone marrow

→ RBCs survive for +/- 120 days after which they are removed from
the circulation by macrophages in the spleen.

→ If not replaced, this will over time lead to a decrease in RBCs, i.e.
anaemia.

→ As RBCs are the main carriers of oxygen (in haemoglobin), a

decrease in RBCs (anaemia) will lead to a decrease in oxygen
delivery to tissues.
Erythropoiesis

INGREDIENTS:
• IRON
• VIT B12
• FOLATE
Thrombopoiesis
(also called megakaryopoiesis)

http://focosi.altervista.org
Thrombopoiesis

→ Thrombopoiesis refers to the production of platelets, which happens

mainly in the bone marrow in adults.

→ Platelets are fragments from megakaryocytes, their direct precursor

cells

→ Megakaryocytes are mainly found around blood vessels (perivascular)

in the bone marrow

→ Thrombopoietin (TPO) is a cytokine (produced mainly by the liver and

kidney) that binds to the thrombopoietin receptor on megakaryocyte
progenitors.

→ This stimulates the production of megakaryocytes, which leads in

turn to an increase in the production of platelets.
Sponge model of thrombopoiesis

→ Control of platelet production

→ TPO receptors on platelets bind to free TPO and remove it from the circulation

→ If platelet count is lower than normal setpoint

→ less TPO will be removed, and more will be available to stimulate platelet production in the
bone marrow
→ Platelets will increase back to normal

→ If platelet count is higher than normal setpoint

→ TPO removed from the circulation before it can stimulate platelet production in the bone
marrow
→ Platelet count will decrease back to normal

Illustration from: Kaushansky K. N Engl J Med 1998; 339:746-754

Granulopoiesis

http://focosi.altervista.org
Lymphopoiesis

http://focosi.altervista.org
Don’t remember the detail, just the principle – lots of growth factors and cytokines involved.
What if things go wrong?
Acute leukaemia

→ Proliferation, maturation or apoptosis problems

→ Differentiation arrest in blastic phase

Bone marrow failure syndromes

→ Aplastic anaemia or Myelodysplastic Syndromes

Final thoughts

→ Stem cells can give rise to all blood cells in the body. Thus, if the stem cells are damaged to destroyed, the bone
marrow will fail.

→ On the other hand, mutations in stem cells can lead to increased bone marrow activity, which may lead to
leukaemia, lymphoma, myeloproliferative neoplasms and other cancers.

→ On the positive side, if the diseased stem cells can be repaired (e.g. gene therapy) or replaced (stem cell
transplantation), the underlying disease could potentially be cured.
Stem Cell Basics – How Blood is Made.

Vernon Louw MedEd YouTube Channel

What happens when Haematopoiesis goes wrong?

Vernon Louw MedEd YouTube Channel

https://vimeo.com/52849443