WHAT IS LEUKEMIA?

(Fragments of the Bernhard Kremens' book for children and their parents.)

You are in a hospital. Consultations þ often painful examinations and check-ups, many indecipherable, unknown words ...

There have been other children in your situation who came to the hospital for the first time and were plagued by the same fears as you have now. It's no wonder! For everything around is so unusual and unknown. Their parents had the same problems yours do - a sick child, constant worries and endless concerns.

This book tells you about the difficulties you may face during the course of treatment and how to deal with them. We wish you success in fighting those difficulties!

What is leukemia? Where does it originate? Scientists and doctors from many countries are doing their best to answer these questions, yet nobody has an exact answer as to where leukemia is coming from. Although, we know where it does NOT come from and that is important.

Leukemia is NOT CONTAGIOUS. You can not infect anyone with it. And of course leukemia is NOT A PUNISHMENT for something you have done wrong (what some may believe).

Your parents may torture themselves with questions about whether they fed you right or doctors examined you in time, etc. But all of it has nothing to do with leucosis (another term for leukemia). You and your parents have to know: NOBODY IS GUILTY THAT YOU HAVE LEUKEMIA.

Have you been interested in the construction of your body? Well ... there is a head þtwo arms, two legs þ a stomach and its content. What else?

Can you imagine a big city without highways? What would happen then? You would be late to school or to work, everyone would be late to dates or to the theater. There wouldn't be anything in the shops, no medicines at the drug-stores, no barnstormers, no sport contests. Life in the city would be still. There's a reason that highways are called "the blood of the city".

You body is like that city and blood here is playing an important role. Leukemia is in direct connection with blood. Blood is not just red water, but something specific, outstanding even! Blood is not a uniform mass. It consists of tiny units, called cells or fundamental elements of blood. Do you want to know what they look like? Then you need to drop some blood on a glass and look at it through a microscope.

The smallest of these units are called thrombocytes. They are like plumbers in your blood vessels. When you injure yourself and the wound is bleeding, thrombocytes turn into stickum and clot the bleeding, as if bandaging it. If there is not enough thrombocytes the bleeding continues and each time you injure yourself you get bruises ( blood is gathering beneath your skin.

One of the reasons for the lack of thrombocytes in your blood is leukemia.

What makes your blood red are erythrocytes (or red blood cells). Those are trucks, that transport a very important load - oxygen. They pick up oxygen from the lungs and transport it to the whole body, to all the organs. Hemoglobin gives them their red color, and carries the atoms of oxygen. The more hemoglobin, the more oxygen a body gets. What happens, though if there are not enough trucks? The ones you have will be overloaded, muscles and the brain will be unable to work without oxygen, a man will feel weak and tired. One of the reasons for low numbers of erythrocytes can be leukemia. If we look at your blood through the microscope we will see that there are not enough erythrocytes in it.

The biggest blood cells are leukocytes or white blood cells. They are the policemen of our body. Among different leukocytes there are two principal types - granular leukocytes and lymphocytes. When inflectional microbe affect your body and start making trouble, granular leukocytes are the ones that fight these hooligans. They do not arrest these 'troublemakers', they ..... eat them. It is harmful for granular leukocytes themselves for in killing microbes they are die themselves. Yet that is their task - they have to treat (cure) the inflammation.

Lymphocytes also belong to the body police, but they work at a distance. They recruit warriors against microbes. Some of them have some kind of a search computer where they keep all the data about different microbes and how they look like. Other lymphocytes produce antibodies that are special chemical substances that attach to microbes. Granular leukocytes recognize such a microbe with 'a trailer' very quickly: "Well! Here comes one more 'bandit'! Get him (and eat him)!" Lymphocytes let the blood cells and nutrients pass by, but they stop and take out the microbes. The lymph nodes connected by lymphatic roads are playing the role of roadblocks.

As good as blood cells may work, they age then finally die and get replaced by new ones. They are formed inside the bones, in their very middle - in the bone marrow.

No one would be able to work soon after being born. You have to grow up, to be educated and to become a professional. The newborn blood cells are just like babies - they all look alike. They grow and learn their future "work", becoming "professional" erythrocytes, thrombocytes, leukocytes right inside the bones....Only a grownup and an "educated" cell can divide into two new ones.

Sometimes the cells 'go mad'. They are dividing at a high speed, not having enough time for growing and learning. They are spreading, filling the bone marrow and then go to blood, unable to do their job. Blood, in its turn, transports them all over the body. Useless for the body organism, they only get in the way of 'smart' cells and eat the nutrients of the grown cells.

These 'crazy' cells that do nothing themselves but only distract everyone are the cells of leukemia. They are called immature blood cells or BLASTS. When they fill the bone marrow and then spread all over the body, a man has leukemia.

The blasts themselves do nothing wrong, save get in everyone's way. Let us imagine that a white rabbit came to visit you. There are hardly such rabbits-visitors, but let us imagine that for a minute. ONE rabbit will not be a problem. The next day we will discover two more rabbits? More the next day .... and in a week everyone will stumble over them all around the house. Now, it is a problem, isn't it? Although these rabbits do nothing wrong, yet it is impossible to stay at home because the rabbits are always in your way.

The blasts behave just like these rabbits.

Among all the cells only the leukocytes are getting sick and crazy. That is why this disease is called leukemia. The microscope is your aide in distinguishing the type of blasts. In most cases the blasts are those cells that should become lymphocytes. That is why they are called lymphatic blasts and this type of leukemia is characterized as 'acute lymphocytic leukemia' (ALL) Lymphatic blast. Granular leukocytes can also develop into blasts. They are called myeloblasts and cause a 'acute myelocytic leukemia' (AML). Different types of leukemia require different forms of treatments.

There are two forms of leukemia. One called "acute" comes very unexpectedly. The other one called "chronic" leukemia is characterized by slow development. Chronic leukemia is rare in children.

What are the symptoms of leukemia?

- tiredness and drowsiness
- fever, cold, inflammations
- bone ache
- pale skin and pale lips
- many bruises
- many tiny blue spots
- enlargement of lymphatic nodes
- enlargement of liver or spleen

Since these symptoms may be significant of any other malady, to define leukemia an additional examination might be required.

Over the last 20 years, doctors have learned much more about what may cause this disease. There is nothing mysterious about the way it's treated. In this book we try to tell you about it If you do not find an answer to the questions you may have, do not be afraid to ask those around you. Go to your mother or father, your doctor or a nurse, other children. It is important that you ask. Do not be afraid. There is no "silly" questions because the one who asks, who wants to learn more, can not be silly!

From the book: Kremense B. What is leukemia? - Munster, 1998.

Pictures: our children with leukemia