Leukemia
M R Y O G E N D R A M E H TA
LECTURER
Leukemia
Leukemia is cancer that starts in the tissue that forms
blood.
Fatal neoplastic disease that involves that blood
forming tissues, abnormal, uncontrolled and destructive
proliferation of one type of white cell and its precures.
Leukemia affects the bone marrow, causing anaemia,
leukopenia, the production of immature cells,
thrombocytopenia and a decline in immunity
Classification
Clinically and pathologically, leukemia is subdivided
into a variety of large groups such as:
Acute
Chronic
Lymphocytic leukemia
(or "lymphoblastic")
Acute lymphoblastic leukemia (ALL)
Chronic lymphocytic leukemia (CLL)
Myelogenous leukemia
(also "myeloid" or "nonlymphocytic")
Acute myelogenous leukemia (AML)
(or Myeloblastic)
Chronic myelogenous leukemia (CML)
Acute leukemia
Rapid increase in the numbers of immature
blood cells.
Crowding due to such cells makes the bone
marrow unable to produce healthy blood cells.
Immediate treatment is required due to the
rapid progression and accumulation of the
malignant cells, which then spill over into the
bloodstream and spread to other organs of the
body
Most common in children.
Chronic leukemia
Excessive build up of relatively mature, but
still abnormal, white blood cells.
Typically taking months or years to progress,
the cells are produced at a much higher rate
than normal cells, resulting in many
abnormal white blood cells in the blood.
Chronic leukemia mostly occurs in older
people, but can theoretically occur in any age
group.
1. Lymphoblastic or lymphocytic leukemias
The cancerous change takes place in a type of
marrow cell that normally goes on to form
lymphocytes, which are infection-fighting immune
system cells.
Most lymphocytic leukemias involve a specific
subtype of lymphocyte, the B cell.
2. Myeloid or myelogenous leukemias
The cancerous change takes place in a type of
marrow cell that normally goes on to form red blood
cells, some other types of white cells, and platelets.
Acute lymphoblastic leukemia
(ALL)
The most common type of leukemia in young
children.
Also affects adults, especially those age 65 and
older.
Standard treatments involve chemotherapy and
radiotherapy.
The survival rates vary by age: 85% in children and
50% in adults.
Subtypes include precursor B acute lymphoblastic
leukemia, precursor T acute lymphoblastic
leukemia, Burkitt's leukemia, and acute
biphenotypic leukemia.
Chronic lymphocytic leukemia (CLL)
Most often affects adults over the age of 55.
Sometimes occurs in younger adults, but it almost never
affects children.
Two-thirds of affected people are men. The five-year
survival rate is 75%.
It is incurable, but there are many effective treatments.
One subtype is B-cell prolymphocytic leukemia, a more
aggressive disease.
Acute myelogenous leukemia (AML)
Occurs more commonly in adults than in children, and
more commonly in men than women.
Treated with chemotherapy.
The five-year survival rate is 40%.
Subtypes of AML include acute promyelocytic
leukemia, acute myeloblastic leukemia, and acute
megakaryoblastic leukemia.
Chronic myelogenous leukemia
(CML)
Occurs mainly in adults
A very small number of children also develop this
disease
Treatment is with imatinib (Gleevec in US, Glivec in
Europe) or other drugs
The five-year survival rate is 90%.
One subtype is chronic monocytic leukemia.
Pathophysiology of leukemia
Characterized by
Diffuse replacement of bone marrow with leukemic cells
Appearance of abnormal immature white blood cells in
the peripheral circulation
Wide spread infiltration of the liver, spleen, lymphnodes
and other tissue throughout the body
Leukemic cells are an immature and mobile type poorly
differentiated, capable of high rate of proliferation and prolonged
life span.
Immature cells Being mobile Rapidly proliferation
Unable to perform Able to travel Little room for
normal function throughout the normal cell
circulatory system production
Ineffective
phagocytosis or Cross the blood-brain Interfere with the
immune cells barrier maturation of normal
bone marrow cells
Infiltrate many body
organs Erythroblasts and
megakakaryoblasts
Signs and symptoms
Anorexia, fatigue, weakness, weight loss
Anaemia, lethargy
Bleeding gum, nose bleed, rectal bleeding, echymosis,
petechiae, retinal hemorrhage, hematuria, metrorrhagia
etc
Prolonged bleeding after minor abrasions or lacerations
High temperatue
Lymphadenopathy and splenomegaly
Palpitation, tachycardia, orthoptic hypotension
Pallor
Dyspnea on exertion
Bone pain
Normal, elevated or reduced WBC count
Low hemoglobin and hematocrit level
Low platelet count
Positive bone marrow biopsy
Diagnosis
History
Personal and family (medical)
Physical examination
Blood test: TC, DC, ESR
Bone marrow biopsy
Chest X-ray
Treatment
Chemotherapy- to kill leukemia cells using strong
anticancer drugs
Biologicla therapy: Interferon therapy to slow the
reproduction of leukemia cells and promote the immune
systems , anti-leukemia activity
Radiation therapy
Bone marrow transplantation
Colony stimulating factors eg epogen
Nursing management
Infection:
Monitor for signs of infection
Initiate protective isolation procedures
Use strict aseptic technique for all procedure
Strict hand washing
Eliminate fresh or raw fruits and vegetables from the
diet and fresh flower from the client’s room and not
leave standing water in the client’s room
Avoid invasive procedure
Assess the urine for color and cloudiness
Avoid crowd
Administered prescribed medications
Instruct the client about a low bacteria diet and avoid
drinking water that hasbeen satnding for 15 minute
Instruct the client to avoid activities that expose the
client to infection, such as changing a pet’s litter box
or working with houseplants or in the garden
Instruct clients that neither the client nor their
household contacts should receive immunization a
live vzccine
Maintain a personal hygiene
Bleeding
The client is at risk for bleeding when the platelet count
falls below 50,000 cells/mm3 and spontaneous bleeding
frequently occurs when the platelet count is fewer than
20,000 cells/mm3
Monitor for signs of bleeding
Administer blood product as order
Handle the client gently
Pad side rails and sharp corners of the bed and furniture
Provide soft foods
Avoid injections if possible, apply firm and gentle
pressure to a needle stick site for at least 10 minute
Avoid rectal suppositories, enemas, thermometers
For female client; count the number of pads or tampons
used
Instruct the client to use soft toothbrush and avoid dental
floss
Instruct the client:
Use only electric razor for saving
Avoid blowing the nose
Avoid constrictive or tight clothing or shoes
Avoid using NSAID and product that contain aspirin
Discourage the client from engaging in activites
involving the use of sharp objects
Fatigue and nutrition:
Assist the client in selecting a well balanced diet
Provide small, frequent meals (little chewing)
Allow adequate rest period
Nursing care provide if chemotherapy, radiation
therapy
Provide psychological support
Instruct home care
Good oral hygiene
Monitor blood transfusion
Protect from sources of infection
