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Fred Cells 102

Posted by Frederick Wasti
Apr 07 2012

In my earlier "Blood Cells 101" entry (from 4/1/12), I tried to give a "Cliff's Notes" version of what blood cells are supposed to be like in normal blood. Then, in my "Fred Cells 101" entry (from 4/3/12), I tried to provide a description of what has been happening to my total white cell count over time. In this post I will try to describe what has been going on with some of my individual types of blood cells over time, at least from diagnosis to the start of treatment. (In later posts I'll take a look at what is happening to them after treatment has begun.)

First, let's take a look at the name of my type of leukemia - it's called "Chronic Lymphocytic Leukemia", or "CLL" for short. Starting at the end and working backwards, the term "Leukemia" (from the Greek words "leukos" for "white" and "haima" for "blood") indicates that CLL is a condition where white blood cells are in excess. The term "Lymphocytic" indicates that the specific culprits are lymphocytes. Finally, the term "Chronic" suggests that (at least for many affected people) the condition can be slow in growing or even indolent, in contrast to being "acute" (or rapidly progressing, as it actually can be in others).

So, since CLL is a cancerous disease involving the lymphocytes, let's take a look at my lymphocyte counts over time:

At first glance, it seems as if "not too much" has been happening to my lymphocytes - that is to say that the trend is indeed an upward trend, but, just from "eyeballing it", the rise doesn't seem to be "overly dramatic". However, please remember that the above graph, and each of the other graphs included in this particular entry, are from the time of diagnosis until the start of treatment (i.e., my "Watch and Wait" period), but the condition had already progressed quite a bit before it was "accidentally diagnosed" from an MRI scan of my arthritic left hip showing enlarged lymph nodes).

If you think back to (or look back at) my "Blood Cells 101" post, you should note that lymphocytes are supposed to be common in blood, but not overly common - that is, the portion of white blood cells that are lymphocytes is supposed to be about 30% or so. Therefore, at the time of my diagnosis, rather than having about one-third of my white cells being lymphocytes, I already had a much larger percentage of lymphocytes present.

One reason why the above graph does not seem to be "overly dramatic" is that, while the lymphocytes have indeed been increasing in number for some time, the total number of white cells - the total leukocytes - has also been increasing. Let's take a look at what the actual ~number~ of lymphocytes has been like (and not just their proportion) over the same period of time:

Perhaps this second graph better shows that, indeed, my lymphocytes have been increasing rather significantly over time. (The numbers on the vertical axis represent the actual number of lymphocytes, in thousands, per cubic millimeter or per microliter of blood.) Keeping in mind that the normal number of all leukocytes in blood is supposed to be about 5,000 to 10,000 per microliter, and that approximately 30% of that number range should normally be lymphocytes, it follows that the normal number of lymphocytes per microliter should be, say, about 2,000 to 3,000. Clearly, at the time of diagnosis, my absolute lymphocyte count was considerably higher than that, in the "teens" of thousands per microliter, and rising over the next year-and-a-half into the forties.

But, exactly what is the problem with this? Why is it so bad to have too many lymphocytes? (After all, don't lymphocytes do good things?) There are several problems with too many of any one type of blood cell, but let's just consider one right now: The excessively high rate of production often means that the bone marrow, responsible for creating all of the types of blood cells, can become so crowded with reproducing aberrant cells that the production of other cell types can slow down and could ultimately virtually stop. Therefore, the number of other cell types (the red cells, other white cells, and/or the platelets) can also start falling, even as the number of aberrant cells is rising so fast that the total white cell count is increasing.

Here is a graph of how my neutrophils have fared during the time in question here:

Not surprisingly, it can be seen that the neutrophil percentage has been dropping at the same time that the lymphocyte percentage has been rising. The absolute neutrophil count (in thousands of cells per microliter) can also be shown to have been falling:

However, it is not just the rate at which the neutrophils seem to have been dropping during this time period that is troubling. Back in "Blood Cells 101" it was pointed out that, in normal blood, neutrophils should be the most numerous leukocyte type (while lymphocytes should be the second most numerous) - there should be about twice as many neutrophils as lymphocytes. It is clear from the above graphs that this has been turned quite upside down - my lymphocytes have easily become the most numerous white cells in my blood, and the proportion of neutrophils has suffered significantly as a result.

Furthermore, it is not so much the proportion of neutrophils that is troubling - the absolute number of neutrophils that have survived my CLL has declined as well. Keeping in mind that neutrophils are supposed to be well over one-half of the white cells in number, there should be perhaps 4,000 or 5,000 in every microliter of blood, and not 1,000 or 2,000. Considering that neutrophils play a very important role in immunity (especially for protection against bacteria and fungi), it should be clear that a declining neutrophil count is ~not~ good news.

I'll take a look at how red blood cells and platelets have been faring in an upcoming entry - please stay tuned for "Fred Blood 103" - <g>.

Categories: Leukemia