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Fred Cells 101

Posted by Frederick Wasti
Apr 03 2012

In my preceding "Blood Cells 101" entry of 4/1/12, I tried to give a "thumbnail sketch" of basic information about blood cells. In this entry I will try to take a look at what has been going on with my total white blood cell numbers up to 3/21/12 (just before my first clinical trial treatment began). [I will do the same for the numbers of individual white cell types and related parameters in other posts, and I will also take a look at how these numbers will have changed (hopefully all for the better - <g>) as a result of treatment in other upcoming posts as well.]

In CLL, the type of leukemia I have, treatment is not generally started as soon as diagnosis has been made. (It has been shown statistically that early intervention does not lead to longer symptom-free survival or to longer life.) Instead, a period of "Watchful Waiting" or "Watch and Wait" (or maybe "Watch and Worry" - <g>) begins, where blood tests and checks for symptoms are made on a regular basis (in my case about every three months or so) to see just when it would be prudent to actually start treatment.

So, let's take a look at my total white blood cell counts since diagnosis in mid-July of 2010:

Time is on the horizontal axis and the total number of white blood cells in thousands of cells per cubic millimeter (or per microliter) is on the vertical axis. The little red diamonds represent the blood tests that I've had during this time period. The blue line is a smoothed curve connecting the "dots" (the little red diamonds), while the "less wiggly" black line is a trendline. (This graph and others that will follow have been generated using Microsoft Excel.)

It should be seen in the above graph that my total number of white cells remained fairly stable for almost a year (hovering in the twenties and thirties), but during the last half-year or so the number has definitely started increasing, reaching the fifties fairly recently.

If you waded through "Blood Cells 101", you might remember that the normal number of white cells per cubic millimeter of blood is supposed to be between about 5,000 and 10,000 or so. Obviously then, at diagnosis I was already well above that range. This is not unusual, however. Many people with leukemia find out first from an "accidental diagnosis", so to speak - that is to say that initial suspicion of leukemia might result from some other test or symptom instead. In my case, the first inkling I had of possible leukemia came from an MRI scan in June of 2010, where the radiologist who read my scan found "abnormal lymphadenopathy in the visualized portion of the left iliac chain", or, in other words, enlarged lymph nodes in part of my lower left abdomen. (The MRI, by the way, focused on my hip left joint, which ended up being replaced with an artificial hip joint in May of 2011.)

As a result of finding enlarged lymph nodes, my primary care physician, Dr. Thomas Browning, suspecting the possibility of leukemia, ordered blood tests performed, and referred me to Dr. Hannah Yamin, a hematologist/oncologist at the Cancer Center at Jordan Hospital in Plymouth. Dr. Yamin had additional blood tests performed, with the diagnosis of CLL being confirmed. [Bummer.]

But, what were my white blood cell counts previous to diagnosis? After all, presumably I once had normal white cell numbers, before the numbers had started to rise. So, I went back and found all of the blood test results I could lay my hands on, and generated the following graph:

It can be seen that my total white cell counts were fairly normal for a long time, and as recently as 2008, but probably started to rise during 2009. I don't have any white cell numbers from 2009, as shown by the sizable gap between the red diamonds (the "dots") and the fairly long straight line during that time period - I did have one blood test during February of 2009, but it was for metabolic parameters, lipids, and a PSA screening, not for blood cell counts. (However, even if I did have a cell count made during 2009, which likely would have shown a somewhat elevated white count, don't forget that it would ~not~ have resulted in earlier treatment - it probably would have resulted only in an earlier diagnosis and a longer "Watch and Worry" period.)

I should point out that having a white blood cell count above 10,000 is not, by definition, necessarily leukemia. Rather, leukocyte counts above 10,000 or so are referred to as "leukocytosis", and can result from a number of other factors besides leukemia, such as infection. (Similarly, counts below 5,000 are referred to as "leukopenia".) Nonetheless, there are a number of blood test results, and anatomical and physiological parameters, that can specifically point to leukemia, and to which type of leukemia is involved, and I will try to cover some of them in other future posts. Please stay tuned for "Fred Cells 102" - <g>.

Categories: Leukemia