before we get into the leukemia stuff I want to remind you guys of the hematopoietic process so we all start off with hematopoietic stem cells and these original hemocytoblast can differentiate into either a myeloid or a lymphoid stem cell now the myeloid and lymphoid stem cells will then differentiate into all of our major red cells white cells and platelets the major thing I want you guys to be aware of is the differences in the lineage the lymphoid stem cell is going to give rise to this thing called a lymphoblast while the myeloid stem cell will give rise to basically everything else other than your lymphocytes so lymphocytes are lymphoid myeloid everything else the next thing I want you guys to be aware of with this is Milo blasts all of your myeloid stem cell stuff they're gonna be made and stay in the bone marrow but your lymphoid stem cells your lymphoblasts these guys some of them will stay in the bone marrow to mature but others will travel other organs like your thymus for your t-cells your spleen and lymph nodes for all of them so these guys travel to other lymphoid organs so all of these things that I'm mentioning here there is a reason for it you will see this come up again now leukemias these are just malignant disorders of your blood or bone marrow and uncontrolled proliferation of malignant leukocytes so all those cells that we just looked at on the previous slide they are going to be playing big roles with all these leukemias so we're going to talk about four of them there are other subtypes that are more rare these are the four big ones these are the four most common ones so we've got AOL AML CLL and CML the leukemias are either all going to be acute or chronic now the cute parts these are going to be rapid these are very very likely to kill them if we do not treat them immediately you are gonna have lots and lots of blast cells so on that previous slide where we saw myeloblast and lymphoblasts that will determine whether it is acute lymphocytic leukemia or acute milo citic leukemia if there's a lot of myeloblasts it's AML if it's a lot of lymphoblast it's a ll so those are some very helpful little clues right there now for chronic leukemias the cells are mature blast cells are immature cells we have mature cells and chronic leukemias but they are abnormal they are reproducing abnormally they are functioning abnormally so it's just slower to progress if you want to see a little bit more of a medical-school chemo hematopoiesis chart this is what you're gonna have to memorize in medical school but we can see our myeloblasts are lymphoblasts but when we start learning leukemia at the graduate school level then we start getting into levels of bands and Mylo sites and meta myocytes and promyelocytes it can get a little overwhelming let's learn the basics with acute you get an accumulation of these blast cells in the marrow and that's suppressing normal hematopoiesis by physically overcrowding the location of where it's growing your red bone marrow only has so much room if you take up all that room with blast cells it's going to make all the rest of it's overcrowded so it's very very rapid these cancers are very very quick to get overwhelming so there's overcrowding and the bone marrow is going to cause pancytopenia just like we saw in a plastic anemia so you're gonna have decreased red cells so you're gonna have anemia signs and symptoms you're gonna have decreased white blood cells neutropenia probably eosinophilia and basophils well but why not lymphocytes remember lymphocytes travel to the spleen the lymph nodes the boat to the thymus so they're in other locations so we still have some protection from them now the platelets they're also made by megakaryocytes so they're also going to be low causing thrombocytopenia increasing your risk for platelet type leading so the bone marrow over crowding it causes bone pain and joint pain now because of the cancer cells that are rapidly dividing uncontrolled they're using tons of calories they're using lots and lots of ATP so you're gonna have hyper metabolism from all those cells with an increased metabolic demand and that's going to cause weight loss and if this thing continues it can lead to severe weight loss where you have muscle wasting and in the data you get cachectic and I'll talk more about that later on hyper metabolism is associated with all cancers now diagnose these you're gonna want to a complete blood count a CBC looking for abnormalities in red cells white cells platelets and you're also gonna want to get a bone marrow biopsy anytime you have pancytopenia get a bone marrow biopsy we're gonna see what's going on in there and really to make a diagnosis once we actually hit the biopsy so if there's a lot of Milo blasts then we're thinking AML if there's a lot of lymphoblasts we're thinking a ll for one of the types of AML's they have our rods and we'll take a look at what those look like yes I'm going to do with vitamin A