What is chronic lymphocytic leukemia (CLL)?Chronic lymphocytic leukemia (CLL) is the most common type of leukemia. CLL usually develops very slowly and many people don’t need treatment for months or years. However, some people need to have treatment straight away. Show
In people with CLL, the body makes too many white blood cells called lymphocytes. When examined under a microscope, the lymphocytes look normal, but they aren’t fully developed (immature) and don’t work properly. Over time, these abnormal lymphocytes build up in the lymphatic system (see below) and may cause large, swollen lymph nodes. They may also fill the bone marrow (see below), reducing the number of normal white blood cells, red blood cells and platelets that can be made. CLL is not infectious and can’t be passed on to other people. To help you understand CLL and its treatment, it’s useful to know a little bit about your blood, how it’s made and what it does. We’ve explained more about this on this page. BloodBlood is made in the bone marrow. This is a spongy material that’s found in the middle of your bones, particularly in your pelvis and backbone (spine). All blood cells are made from stem cells. The bone marrow is a safe place for the stem cells to divide and grow into fully developed (mature) red blood cells, white blood cells and platelets. These are then released into your blood to carry out different functions:
The levels of these cells in your blood are measured in a blood test called a full blood count (FBC). The figures below are a guide to the levels usually found in a healthy person.
These figures can vary from hospital to hospital. They can also be slightly different in people of African-Caribbean and Middle Eastern origin. Your doctor or nurse will be able to tell you what figures they use. The figures might look complicated when they’re written down, but in practice they’re used in a straightforward way. For example, you’ll hear doctors or nurses saying things like ‘your hemoglobin is 14’ or ‘your neutrophils are 4’. Many people with CLL soon get used to these figures and what they mean. Your doctors will often look at the way your blood test results change over time (trend) to decide what, if any, treatment is needed. LymphocytesPeople with CLL make too many lymphocytes (a type of white blood cell). Normally, lymphocytes are an important part of the body’s defense against bugs such as bacteria, fungal infections and viruses. They fight infections in several ways:
Lymphocytes travel around the body in the blood and the lymphatic system. The lymphatic systemThe lymphatic system is part of the immune system – the body’s natural defense against infection and disease. It’s made up of organs such as the bone marrow, thymus, spleen and lymph nodes. The lymph nodes, which are found throughout the body, are connected by a network of tiny lymphatic tubes (ducts). Lymph nodes can be felt in the neck, armpit and groin. There are also lymph nodes in the chest and the tummy (abdomen). The lymphatic system has two main roles: it helps to protect the body from infection and it drains fluid from the body’s tissues. Risk FactorsThere are a number of factors that can increase the risk of developing CLL: AgeThe risk of developing CLL increases with age. Most people with CLL are over 60: it’s rare in people under the age of 40. GenderCLL is more common in men than in women. Family historyAlthough most people with CLL have no family history of the disease, studies show that there is an increased risk of developing CLL if you have a first degree relative (parent, sibling or child) who has it. This is known as familial CLL. If anyone else in your family has CLL, it’s important to let your specialist know. However, most people who have a relative with CLL will never develop it themselves. EthnicityCLL is most common in people of European origin, slightly less common in people of African origin, and rare in Asian people. Symptoms of chronic lymphocytic leukemia (CLL)Chronic lymphocytic leukemia (CLL) develops slowly and many people have no symptoms in the early stages. It’s often discovered by chance when a blood test is taken for another reason, such as before an operation or as part of a routine health check. The signs and symptoms of CLL can include the following:
. Chronic myeloid leukemia (CML) is a rare form cancer. CML can occur at any age but is more common in middle-aged and older people. It’s rare in children. CML usually develops very slowly, which is why it’s described as a ‘chronic’ leukemia. Many people don’t need treatment for months or years. However, some people need to have treatment straight away. People with CML make too many of a type of white blood cell called a granulocyte, which is why CML is sometimes called chronic granulocytic leukemia (CGL). When examined under a microscope, the granulocytes aren’t fully developed (immature). Over time, these abnormal white blood cells collect in the spleen, causing it to enlarge. They also fill the bone marrow reducing the number of normal white blood cells, red blood cells and platelets that are made. The spleen is an organ on the left side of the tummy underneath the ribs. It produces small numbers of lymphocytes, stores blood cells, and destroys older, damaged blood cells. It’s part of the lymphatic system, which also includes other lymphatic organs such as the bone marrow and the lymph nodes (glands). To help you understand CML and its treatment, it’s useful to know a bit about your blood, what it does and how it’s made. BloodBlood is made up of blood cells in a liquid called plasma. The blood cells are made in the bone marrow. This is a spongy material that’s found in the middle of your bones, particularly in your pelvis and backbone (spine). Normally, millions of new blood cells are made every day to replace the old and worn-out blood cells. All your blood cells are made from cells called stem cells. There are two types of stem cell:
To begin with, the new blood cells are immature. They don’t look like red blood cells, platelets or white blood cells, and they can’t yet do the jobs they’re supposed to. These immature cells are called blast cells. Usually, blast cells stay in the bone marrow until they have matured into red blood cells, platelets or white blood cells. In the bone marrow, the stem cells divide and grow to form fully developed (mature) red blood cells, platelets and white blood cells. These are then released into your blood to carry out different functions:
The levels of these cells in your blood are measured in a blood test called a full blood count (FBC). The figures below are a guide to the levels usually found in a healthy person.
These figures can vary from hospital to hospital. Your doctor or nurse will be able to tell you what levels they use. They can also be slightly different in people of African-Caribbean and Middle Eastern origin. The figures might look complicated when they’re written down, but in practice, they’re used in a straightforward way. For example, you’ll hear doctors or nurses saying things like ‘your hemoglobin is 14’ or ‘your neutrophils are 4’. Most people with CML soon get used to these figures and what they mean. How CML developsAll cells have a set of instructions that tell them what to do and when to do it. These instructions are stored inside the cells as genes. Each gene has its own distinct set of instructions that control a particular aspect of how the cell behaves. For example, some genes tell a cell when to rest, others tell it when to grow, and others tell it how to mature into an adult cell so it can perform its normal functions in the body. The genes are organized into structures called chromosomes. CML develops when, by mistake, a gene gets moved from one chromosome to another when a cell is dividing. This causes two genes that are normally completely separate to join together (fuse). This new, abnormal ‘fusion’ gene stops the bone marrow stem cell from maturing into a normal blood cell. These abnormal cells are the leukemia cells or blast cells. When doctors look at the leukemia cells they can often see a chromosome that looks different. This new chromosome, caused by the fusion of the two genes, is called the Philadelphia chromosome. Philadelphia chromosomeMost people with CML (more than 95 out of 100) have the Philadelphia chromosome in all their leukemia cells. This is known as Philadelphia chromosome positive CML, or Ph+CML. The Philadelphia chromosome isn’t inherited, so it’s not something you were born with and it can’t be passed on to your children. How the Philadelphia chromosome developsMost cells in the body contain 23 pairs of chromosomes. They are numbered from Symptoms of chronic myeloid leukemiaCML develops slowly and many people don’t have symptoms in the early stages. It’s often discovered by chance when a blood test is done for another reason, such as before an operation or as part of a routine health check. If there are symptoms in the early stages of CML, they develop gradually and are usually mild. They tend to be non-specific and can easily be confused with the symptoms of more common illnesses, such as flu. The signs and symptoms of CML can include the following:
If you have any of these symptoms, it’s important to see your doctor, but remember they are common to many illnesses other than CML. Become a PatientAt The Center for Cancer and Blood Disorders, our board-certified physicians provide cancer treatment to more than 12,000 patients annually at our locations in Fort Worth – Central Campus, Fort Worth – Southwest, Arlington, Weatherford, Burleson, Granbury, Mineral Wells, and Stephenville. We offer you the latest advances in chemotherapy, radiation therapy, immunotherapy, hormonal therapy, and biological therapy. We also offer you the opportunity to take advantage of groundbreaking cancer treatment available only through clinical trials and cancer research. What does high neutrophils and high lymphocytes mean?The neutrophil-lymphocyte ratio is an inexpensive and simple inflammatory marker. A higher ratio, indicative of an acute hyperinflammatory response or diminished overall physiologic health status, has been associated with poor prognoses.
What is the relationship between neutrophils and lymphocytes?Exposure to viral or bacterial pathogens increases the number of neutrophils with a relative decrease in lymphocytes, leading to elevated neutrophil to lymphocyte ratio (NLR).
Why would absolute neutrophils be high?The number of neutrophils in your body may increase due to: Infections. Inflammation. Injury.
Should I worry about high absolute neutrophils?Absolute neutrophil count tells the doctor the number of neutrophils in your blood. A count below 2500 may mean your immune system isn't working properly and you're at risk for infection. 2 A count above 6000 may be a sign of infection, inflammation, leukemia, or intense physical or emotional stress.
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