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Chronic leukemia
Chronic leukemias affect specialized blood cells that are partially through the process of maturation. Chronic lymphoblastic leukemias (CLL) often cause an enlargement of the liver and spleen. Involvement of the lymph nodes in CLL is often called small lymphocytic lymphoma. Learn how small lymphocytic lymphoma can transition to diffuse B cell lymphoma. Created by Nauroz Syed.
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- Can there be chronic myloid leukemia?(15 votes)
- Could someone explain the difference between Hodgkins and Non-Hodgkins lymphoma?(6 votes)
- Non-Hodgkin Lymphoma frequently occurs at peripheral extra nodal sites and is spread in a more unpredictable fashion. Hodgkin lymphoma is usally localized to a single axial grouping and spreads to lymphoid tissues in a more predictable fashion. Hodgkin lymphoma also has a characteristic neoplastic giant cell know as a Reed-Sternberg cell that is seen when a lymph node biopsy is examined under a microscope.(13 votes)
- What about CML? The entire video was focused on CLL and CML was not even mentioned in passing.(5 votes)
- Why do cells that cause chronic leukemia reproduce slower than the more immature cells that cause acute leukemia?(3 votes)
- Chronic leukemias affect specialized blood cells that are partially through the process of maturation. Chronic lymphoblastic leukemias (CLL) often cause an enlargement of the liver and spleen. Involvement of the lymph nodes in CLL is often called small lymphocytic lymphoma. Learn how small lymphocytic lymphoma can transition to diffuse B cell lymphoma.(1 vote)
- What should a person with leukemia eat.and what causes leukemia(2 votes)
- They could eat normal things, and mutations cause leukemia. Bwahahahaha! (just kidding about that evil laugh)(1 vote)
- Why does richter syndrome occur(2 votes)
- A case of RS may have arisen by one of two different routes: a transformation of the CLL cells into lymphoma, or the appearance of an unrelated lymphoma.
It is thought that genetic defects may introduce the additional abnormalities necessary to transform CLL cells into Richter's syndrome cells.(2 votes)
- What would happen if a mature blood cell had leukemia? Can a mature blood cell actually be diagnosed with leukemia?(1 vote)
- The patient might have a lot of one type of cell. And, this is extremely rare, so you don't have to worry about it.(2 votes)
- What kind of mutation happens to form the Richter transformation?(1 vote)
- what happens when a cll cell ruptures? like what does it look like?(1 vote)
- Can there be cronic tyriods limpthodes(1 vote)
Video transcript
Voiceover: Now we’re going to
talk about chronic leukemias, and chronic leukemias come
from these cells over here. Just like we did with the
acute leukemias we can split up the chronic leukemias
into chronic lymphoid leukemias and chronic myeloid leukemias. We’re actually going
to start off by talking about the chronic lymphoid leukemias. We’re going to start off the
chronic lymphoid leukemia which is usually just abbreviated CLL. Even though the name doesn’t tell you this CLL is a B-cell leukemia,
so it comes from B-cell. CLL develops from this cell over here, so I’m just going to circle
that and you can see from this diagram that the CLL cell
is sandwiched in between the B-lymphoblast and the B-lymphocyte. It kind of exists in this
fuzzy area, this gray zone in between the immature
cell and the mature cell, and because of that it has
certain characteristics that are more similar
to the immature cell, and it has other characteristics that make it more similar to the mature cell. For example in terms of the appearance, how the CLL cell looks it actually looks pretty similar to a mature B-cell. If you were to look at a CLL cell it looks pretty much the same as a mature B-cell. Now something that you
couldn’t tell just by looking at the cell is
that a CLL cell is actually not as structurally
strong as a mature B-cell. It’s weaker it’s more fragile,
and if you took for example, if you took a drop of blood from somebody, from a patient who has
CLL and you wanted to look at that drop of blood underneath
a microscope you would then place that drop of blood
onto a microscope slide, and you’d do some preparations and then you’d stick it underneath a microscope. Well that whole process of
putting the cells the blood cells onto the slide causes the
fragile CLL cells to rupture. That’s how fragile they
are, they’ll rupture, and those ruptured CLL cells
are called smudge cells. It’s pretty cool because if you
didn’t know that the patient has CLL leukemia just by
taking a look at drop of their blood if you were to see
smudge cells that would kind of hint you in the
direction of a CLL diagnosis. Okay, so that’s the
appearance of these cells. Well, what about where these
cells go to, where they live? A normal B-cell a normal
healthy mature B-cell after it’s released from the bone marrow into the blood it will
travel to three organs. It’ll go to the lymph node,
the liver and the spleen, and it’ll go to these three organs. It’ll hang out over there
and mature a little bit more, and it’ll wait for pathogens like bacteria and viruses to show up. When they do the B-cells will activate and they’ll attack the pathogens. That’s the job of the B-cells right? It turns out that in this
regard our CLL cells are also mature enough to home to these same sites. The CLL cells also go to the
lymph node, liver and spleen after they’re released
from the bone marrow. Now, let’s think about that for a second. In CLL we have a cancer, we have a leukemia cancer of the lymphoid cells. If all of those lymphoid
cells are going to these three organs what’s going
to happen to the organs? They’re going to get bigger
right, and you see that most significantly with
the lymph nodes where after the CLL cells will go to the
lymph nodes they’ll cause a generalized, meaning
throughout the body, generalized meaning throughout the body, lymphadenopathy. So, it’ll cause a generalized
enlargement of the lymph nodes throughout the body okay, and that has a special name. Why it has a special name I don’t know, but it has a special name. If a lymph node is enlarged
in a patient who has CLL you can assume that that
lymph node is enlarged because it’s filled with
CLL cells and that lymph node will be called a
small lymphocytic lymphoma. Oma means mass, and lymph refers to the fact that these are lymphoid cells, so it’s talking about a small mass of lymphoid or small mass of CLL cells okay? This brings us to a
really important point, after these CLL cells
traveled to the lymph node, and they start to take up
more space inside there these cells can then
acquire additional mutations that cause them to grow more quickly, more rapidly, and more out of control. Mutations that make these
cells stickier for one another and the result of
that is that these cells then form a genuine a true mass. That is referred to as a
diffuse b-cell lymphoma, and that process by which this occurs is called a Richter transformation. In a patient who has CLL
you may see generalized enlargement of the lymph
nodes throughout the body, and after some time you may see that one lymph node in particular
starts getting very big. That usually signifies that
that inside that lymph node there’s been a transformation
to a diffuse B-cell lymphoma. Now, let’s move on to the
function of the CLL cells. Are they more mature or more immature in terms of their function? Well, what’s a function of normal B-cells? Usually one of the most
important functions of a B-cell is to make antibodies right? In regards to making
antibodies these CLL cells they fall short, they don’t do
a very good job at all, and because of that in
patients who have CLL you see a decrease in the number
of antibodies in the blood. So you see a hypo, hypo meaning too few, gamma globulin, you may
of heard of immunoglobulin or gamma globulin being
different words to use to refer to antibodies, emia
meaning in the blood. So, hypogammaglobulinemia, meaning too few antibodies in the blood,
and that’s because the CLL cells do a very poor job
of making good antibodies, but that doesn’t mean
these cells don’t try. In fact, they try pretty
hard they actually try to make antibodies, but
unfortunately when they do make antibodies they do
such a bad job that instead of the antibodies attacking
bacteria and viruses and parasites, the antibodies
start attacking our own cells. Specifically they start
attacking our red blood cells causing them to rupture and die, and that’s referred to as
an auto, auto means self, immune, so an immune
response that is attacking our own body, hemolytic anemia okay? So we see a hemolytic anemia
or a destructive anemia, red blood cells being
destroyed because of an immune response attacking
our own red blood cells. Now, that’s pretty much CLL in a nutshell. There’s another type of
chronic lymphoid leukemia that develops from a
B-cell and it’s called a hairy cell leukemia, and
there are other chronic lymphoid leukemias that
develop from T-cells. Specifically there’s
adult T-cell leukemia, and there’s mycosis fungoides. I’m not going to go into
much depth about them, but it’s always good to
know that they do exist, but CLL when it comes to
chronic lymphoid leukemia CLL really is where the money is at in terms of what you need to know.