HEMATOLOGICAL DISORDER

OLEH :
NASRULLAH HASAN
RAHMAT MUHAIMIN S

POLITEKNIK KESEHATAN KEMENKES

MAKASSAR

2016
 HEMATOLOGICAL DISORDER
A. DEFINITION

Leukemia is the proliferation of irregular or accumulation of white blood cells in the bone
marrow replaces the element of normal bone marrow ( Smeltzer , 2002) .

Leukemia is a malignancy of the blood cells form builder tool proliferasio young
hemopoetik pathological cells characterized by the presence of bone marrow failure in
forming normal blood cells and their infiltration into other body tissues ( Mansjoer ,
2002) .

B. ETIOLOGY

a. Genetic Deviations their chromosomes. The incidence of leukemia increased in

patients with congenital abnormalities, among others, in Down syndrome,
Bloom syndrome, Fanconi's anemia, Wiskott-Aldrich syndrome, Ellis Van
Creveld syndrome, syndrome Kleinfelter, D-Trisomy syndrome, Syndrome von
Reckinghausen, and neurofibromatosis. Congenital abnormalities have been
strongly linked with the change of gene information, for example on
chromosome 21 or Trisomy C-group, or a pattern of chromosomal instability, as
in aneuploidy.

1. Siblings Reported a high risk of acute leukemia in identical twins where

cases of acute leukemia occurred in the first year of birth. This applies
also to families with very high incidence of leukemia.

2. Environmental Factors Several environmental factors in the know can

cause chromosomal damage, for example: radiation, chemicals, and
drugs associated with an increased incidence of acute leukemia,
particularly ANLL.

b. Virus.In many experiments have found the fact that RNA viruses cause leukemia in
animals, including primates. The study in humans found an RNA-dependent DNA
polymerase in leukemia cells but not in normal cells and enzymes derived from Type C
virus is an RNA virus that causes leukemia in animals. One of the virus that are proven to
cause leukemia in humans is the Human T-Cell Leukemia. This type of leukemia is caused
by T-Cell Acute Leukemia. This virus was discovered by Takatsuki et al.

c. Chemicals and DrugsChronic exposure of chemicals (eg benzene) are associated with an
increased incidence of acute leukemia, for example, the cobbler who are often exposed to
benzene. In addition to benzene some other materials associated with a high risk of AML,
 among others: product - oil products, paint, ethylene oxide, herbicides, pesticides and
electromagnetic fields.While on drugs, anti-neoplastic drugs (eg: alkilator and topoisomere
II inhibitors) can lead to chromosomal aberrations that cause AML. Chloramphenicol,
phenylbutazone, and methoxypsoralen reported to cause bone marrow failure, which
gradually became AML.

d. RadiationA close relationship between radiation and leukemia (ANLL) was found in
patients anxylosing spondylitis who received radiation therapy, and in other cases: as an
increased incidence of leukemia among residents of Japanese survivors of atomic bomb
blasts.Increased risk of leukemia was observed even in patients receiving radiation therapy,
for example: thymic enlargement, the workers were exposed to radiation and radiological.

C. PATOFISIOLOGY

Clinical manifestations of acute leukemia patients due to the replacement of cells in the
bone marrow by leukemic cells, causing impaired production of red blood cells.
Depression causes purpura platelet production and the tendency to bleed. The failure of
the cellular defense mechanism for the replacement of white blood cells by leukemic
cells, which causes the high possibility of infection. Infiltration of leukemic cells to vital
organs such as the liver and spleen by leukaemic cells which can cause enlargement of
these organs.

Whereas in patients with Leukemia itself is caused by:

a) Normally, the bone marrow is replaced with malignant tumors, imaturnya blast
cells. Their proliferation of blast cells, erythrocytes and platelets disrupted
production that will cause anemia and trombositipenia .

b) reticuloendothelial system will be affected and cause the immune system and
susceptible to infection.

c) The manifestation will appear on the picture of the failure of the bone marrow and
organ infiltration, the central nervous system. Disturbances in the nutrition and
metabolism. Bone marrow depression that will impact on the leukocytes,
erythrocytes, clotting factors and increased tissue pressure

d) The existence of extra medullary infiltration will result in enlargement of the liver,
lymph, lymph nodes, and joint pain.
D. TYPES OF LEUKIMIA

1. Chronic Lymphocytic Leukemia (Chronic lymphoblastic leukemia / CLL), a type of

leukemia is more common in the elderly over 55 years.

2. Chronic Myeloid Leukemia (Chronic Myelogenous Leukemia / CML), a type of

leukemia that affects adults.

3. Acute Lymphocytic Leukemia (acute lymphoblastic leukemia / ALL), a type of

leukemia that are common in people with children. However, ALL also affect adults.

4. Acute Myeloid Leukemia (Acute Myelogenous Leukemia / AML), a type of leukemia

that attacks on people with children and adults.

E. ASSESMENT

1. SUBJECTIVE DATA

- fatigue

- pressure drop inspiration and aspiration

- palpitations

- Anorexia

- Tachycardia

- weakness

2. OBJECTIVE DATA

- fever: frequent infections

- skin: pallor due to anemia

- organ enlargement: spleen, liver

- Abnormal heart rate response activity

F. NURSING DIAGNOSIS

1. risk for infection related to immature or abnormal leukocytes.

2. activity intolerance related to hypoxia and weakness.

3. fear related to diagnosis

4. altered tissue perfusion related to anemia.

5. fatigue related to anemia.

G. IMPLEMENTATION

1. Goal: prevent, control, and treat infection

a. protective isolation if indicated

b. observe for early signs of infection

c. give antibiotics as ordered

d. mouth care: examine for new lesions

2. Goal: assess and control bleeding anemia

a. activity: restrict to prevent trauma

b. observe for hemorrhage: vital signs, urine

c. control localized bleeding

d. use soft bristle or foam rubber tooth brush to prevent gingival bleeding.

e. give blood : observe for transfusion reactions

H. EVALUATION

1. Alleviate symptoms : obtain remission

2. Prevent complications : infection

3. Ventilates emotions accepts and deals with anger

4. Experiences peaceful death.