Explainer: what’s actually in our blood?

[AussieNeil]

Blood is vitally important for our body. As it’s pumped around our body through veins and arteries, it transports oxygen from our lungs to all of the other organs, tissues and cells that need it. Blood also removes waste products from our organs and tissues, taking them to the liver and kidneys, where they’re removed from the body.

About 45% of our blood consists of different types of cells and the other 55% is plasma, a pale yellow fluid. Blood transports nutrients, hormones, proteins, vitamins and minerals around our body, suspended in the plasma. They provide energy to our cells and also signal for growth and tissue repair. The average adult has about five litres of blood.

The different types of blood cells include red blood cells, platelets, and white blood cells, and these are produced in the bone marrow, in the centre of our bones.

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White blood cells are part of the body's immune system (which) detect and fight viruses and bacteria. There are five major types of white blood cells and they make up less than 1% of blood.

Full article by Denese Marks, Adjunct Associate Professor, University of Sydney: theconversation.com/explain...

Note that in some leukaemias, a high white blood cell count can cause what's termed sludging. Fortunately for us with CLL, our CLL/SLL cells are quite small - almost as small as red blood cells, hence the name Small Lymphocytic Leukaemia for the variant of CLL/SLL where B-cells are barely present in the blood. Prof. Terry Hamblin notes on his blog "The highest white count that I have seen in CLL is 800,000/cu mm though Tom Kipps told me of a patient with 1,400,000/cu mm. The odd thing is that neither of us has ever seen leukostasis in CLL. This is the condition, often seen in myeloid malignancies where sludging of white cells in blood vessels cuts off the circulation to a particular organ." mutated-unmuated.blogspot.c...

Contrast that with the normal white blood cell count of between 4,000 and 11,000 (4 to 11 for some of us with a different reference volume) and you can appreciate that even with counts that some of us get to on watch and wait, or after we start Ibrutinib, we are generally well short of these record counts and not in danger from sludging. That's why there is no lymphocyte/white blood cell count threshold for starting treatment, though oncologists not that familiar with CLL have been known to unnecessarily start treatment when CLL patients counts exceed 100(thousand).

I can highly recommend Dr Susan Leclair's informative videos for those wishing to know more about the role of the different blood cells and what our blood tests tell us about our CLL: healthunlocked.com/cllsuppo...

Those wishing to plot their trends can use spreadsheet templates described in this post:

healthunlocked.com/cllsuppo...

Don't get too concerned about small changes; it's the overall trends that are important. You'll get different results even on the same day, depending on when your blood sample was taken, plus there's the inherent limitations in test equipment precision and accuracy, which is particularly a factor for platelet counts:

healthunlocked.com/cllsuppo...

healthunlocked.com/cllsuppo...

Neil

(This post is unlocked - so it and any replies can be found via an Internet search)

[GrapeGrower1]

Excellent info and excellent Pic!

[AdrianUK]

Thanks for a great link and info Neil.

Just as a slight bit of additional information for newer readers,

It is absolutely correct that there is no automatic level at which we must be treated but it’s also important to stress the opposite point which is that some people do need to be treated with relatively low lymphocyte counts too.

I saw Prof Hillmen last year and at the time my lymphocyte count was still below 100,000 but because of how quickly it was rising, how fast my nodes were growing, and my symptoms he advised treatment soon (and my own cll specialist independently suggested the same thing at my next appt a couple of months later).

At the time Prof Hillmen explained that he sometimes advised treatment for people who had much lower levels than I had at the time, but equally that he sometimes advises not to treat for people who have much much higher levels than I did at that time.

He stressed that the rate of change was really important and that rate of change often correlated with other symptoms and signs that indicate its time to treat.

It seems the body can cope quite well with changes that happen slowly so if it takes you say ten years after diagnosis to get to 100,000 then you may be able to carry on for another ten years or more before treatment. But if you are rapidly doubling then the chances are high you will also have other indications for treatment.

Hope that helps some of our newer readers. All the more reason why it’s important to see a CLL specialist to help make treatment decisions.