Normal Bone Marrow, Blood, and Lymphoid Tissue

Different types of leukemia start in different types of blood cells. It helps to understand some basics about blood cells.

Bone marrow

Blood cells are made in the bone marrow.

Bone marrow is the soft inner part of some bones, like the skull, shoulder blades, ribs, pelvis, and backbones. Bone marrow is made up of:

• A small number of blood stem cells
• More mature blood-forming cells
• Fat cells
• Supporting tissues that help cells grow

Inside the bone marrow, blood stem cells divide and mature to make new blood cells. During this process, the cells become either lymphocytes (a kind of white blood cell) or other blood-forming cells. These other blood-forming cells mature into red blood cells, white blood cells (other than lymphocytes), or platelets.

Types of blood cells

Red blood cells carry oxygen from the lungs to all other tissues in the body, and take carbon dioxide back to the lungs to be removed. Having too few red blood cells (anemia) can make you feel tired, weak, and short of breath because your body tissues aren't getting enough oxygen.

Platelets are actually cell pieces made by a type of bone marrow cell called the megakaryocyte. Platelets are important in plugging up holes in blood vessels caused by cuts or bruises. Having too few platelets (thrombocytopenia) may cause you to bleed or bruise easily.

White blood cells help the body fight infections. Having too few white blood cells (neutropenia) lowers your immune system and can make you more likely to get an infection.

Types of white blood cells

Lymphocytes are mature, infection-fighting cells that develop from lymphoblasts, a type of blood stem cell in the bone marrow. Lymphocytes are the main cells that make up lymphoid tissue, a major part of the immune system. Lymphoid tissue is found in lymph nodes, the thymus gland, the spleen, the tonsils, and adenoids. It's also scattered throughout the digestive and respiratory systems and the bone marrow. The 2 main types of lymphocytes are:

• B lymphocytes (B cells) protect the body from invading germs by developing (maturing) into plasma cells, which make proteins called antibodies. The antibodies attach to the germs (bacteria, viruses, and fungi), which helps other white blood cells called granulocytes recognize and destroy them. B lymphocytes are the cells that most often develop into chronic lymphocytic leukemia (CLL) cells.
• T lymphocytes (T cells) can recognize cells infected by viruses and directly destroy these cells. They also help regulate the immune system.

Granulocytes are mature, infection-fighting cells that develop from myeloblasts, a type of blood forming cell in the bone marrow. Granulocytes have granules in them that look like spots under the microscope. These granules contain enzymes and other substances that can destroy germs, such as bacteria. The 3 types of granulocytes -- neutrophils, basophils, and eosinophils -- are distinguished under the microscope by the size and color of their granules.

Monocytes develop from blood-forming monoblasts in the bone marrow and are related to granulocytes. After circulating in the bloodstream for about a day, monocytes enter body tissues to become macrophages, which can destroy some germs by surrounding and digesting them. Macrophages also help lymphocytes recognize germs and start making antibodies to fight them.