GROUP 1

Apolonio, Leizel, R.
Corpuz Rolyn
Mañalac Joelle Anne
Señeres Loui Anne
INTRODUCTION
Leukemia is a cancer that starts in blood stem cells. Stem cells are basic cells that
develop into different types of cells that have different jobs.

Blood stem cells develop into either lymphoid stem cells or myeloid stem cells.

Lymphoid stem cells develop into lymphocytes, a type of white blood cell.
Lymphocytes help fight infection and destroy abnormal cells. The 3 types of
lymphocytes are B cells, T cells and natural killer (NK) cells.
Myeloid stem cells develop into red blood cells, granulocytes, monocytes or platelets.
Red blood cells carry oxygen to all tissues of the body. Granulocytes and monocytes are
types of white blood cells that destroy bacteria and help fight infection. Platelets form
clots in damaged blood vessels to stop bleeding.
As the stem cells of the blood develop, they become blast cells (blasts), which are
immature blood cells.

In leukemia, there is an overproduction of blast cells. These blast cells develop

abnormally and don’t develop into mature blood cells. Over time, the blast cells crowd
out normal blood cells so that they can’t do their jobs. When leukemia is diagnosed,
these blast cells may be called leukemia cells.
EPIDEMIOLOGY
The causes of acute leukemia and lymphomas are still largely
unknown. These malignancies account for approximately 6% of cases of
cancer in the US population, and active research efforts are now
underway to define etiologically important genetic or environmental
factors for these conditions. Recent epidemiologic studies have focused
on international variations, secular trends, genetic syndromes, familial
aggregation, chromosomal abnormalities, environmental exposures,
and unique subgroups defined either demographically or biologically.
In the US, one person is diagnosed with a blood cancer every
three minutes. These blood cancers include leukemia and lymphoma,
myeloma and myelodysplastic syndromes, according to the Leukemia
and Lymphoma Society (LLS).
The Department of Health (DOH) ranks leukemia as the 4th
cancer killer in the Philippines. A Philippine Health Advisories Report
places leukemia as the 5th in overall mortality. Meanwhile, a Globocan
Report in 2012 said that the incidence of leukemia, lymphoma, and
multiple myeloma in the Philippines is at 6,858.
ETIOLOGY
The cause of leukemia is unknown.
Increased risk is associated with large doses of
ionizing radiation, certain chemicals such as benzene
and infection with specific viruses and Human T cell
leukemia-lymphoma virus I (HTLV-I)
 Cigarette smoking and exposure to electromagnetic
fields also have been proposed to e causative.
 Genetic factors may cause cytogenetic abnormalities
that affect transcriptional cascades of myeloid
precursor cells. This change is called the “
Philadelphia chromosome.” It results in the bone
marrow making an enzyme, called tyrosine kinase,
that causes too many stem cells to become white
blood cells (granulocytes or blasts).
 Philadelphia chromosome. A piece of chromosome 9 and a piece of
chromosome 22 break off and trade places. The bcr-abl gene is formed on
chromosome 22 where the piece of chromosome 9 attaches. The changed
chromosome 22 is called the Philadelphia chromosome.
RISK FACTORS

1. Smoking
The only proven lifestyle-related risk factor for AML is smoking.

2. Chemical exposures

3. Certain chemotherapy drugs-dugs called alkylating agents and

platinum agents are linked to an increased risk of AML that peaks
about 8 years after chemo.

4. Radiation exposure

5. Family history
SCREENING AND DETECTION
 Determining the exact condition, and what specific type, often
takes more than one approach:
 The following tests and procedures may be used:
 Physical exam and history examines the patient’s past
illnesses and treatments, and any signs of disease, such as a
swollen spleen, lumps, or anything else that seems unusual.
 Complete blood count (CBC): A sample of blood is drawn to
check for the number of red blood cells, white blood cells and
platelets, as well as the amount of hemoglobin (the protein
that carries oxygen) and the portion of the sample made up of
red blood cells.
 Peripheral blood smear: This procedure checks a sample of
blood for cells that look “hairy,” the number and kinds of white
blood cells and changes in the shape of blood cells.
 Blood chemistry studies: These test a blood sample for the
amounts of certain substances released into the blood by
organs and tissues in the body to look for signs of disease.
 Bone marrow biopsy: This test involves
aspiration of bone marrow, blood and a small
piece of bone from the hipbone or breastbone
to look for microscopic signs of cancer.
 Immunophenotyping: A laboratory test
examines the antigens or markers on the
surface of a blood or bone marrow cell to see
what type of cell it is. This test helps diagnose
the specific type of leukemia by comparing the
cancer cells to normal cells of the immune
system
 Flow cytometry: This laboratory test measures the number of
cells in a sample, the percentage of live cells and certain
characteristics of cells, such as size, shape and the presence
of tumor markers on the cell surface. Measurements are based
on how the light-sensitive dye reacts to the light.
 Cytogenetic analysis: This laboratory test looks
at cells in a sample of tissue under a
microscope to look for certain changes in the
chromosomes. The characteristic chromosomal
abnormality called Philadelphia (Ph)
chromosome (90-95%)
 Comprehensive gene profile: A laboratory test
to identify gene aberrations to personalize
treatment.
 CT scan: This procedure makes a series of
detailed pictures of areas inside the body,
which are taken from different angles and use
contrast dye to look for things such as swollen
lymph nodes or spleen.
PREVENTION
there is no known way to prevent most types of
leukemia.
some types of leukemia can be prevented by
avoiding:
high doses of radiation
exposure to the chemical benzene
smoking and other tobacco use
certain types of chemotherapy used to treat other
cancers
 Classified on the basis of cell types predominantly involved – myeloid or
lymphoid
 Acute: predominance of undifferentiated leucocyte precursors or leukemic
blasts – Acute myeloblastic leukemia (AML) - at all ages – Acute
lymphoblastic leukemia (ALL) – primarily a disease of children and young
adults
 Chronic: late precursor series of leucocytes – Chronic myeloid leukemia (CML)
– middle age – Chronic lymphocytic leukemias (CLL) - elderly
CLINICAL FEATURES

AML and ALL share many common clinical

features - difficult to distinguish on clinical
features alone.
• 25% of patients with AML: preleukemic
syndrome with anemia may be present for a
few months to years prior to the development
of overt leukemia.
EARLY WARNING SIGNS
Purplish or tiny red spots on the skin
Pain in the bones or joints
Headaches
Unusual lumps or swollen lymph nodes
Feeling weak and tired unusually
Bleeding and bruising easily
Frequent fevers and infections
Unexplained weight loss
Unusual breathing
Abdominal pain or swelling

LATE WARNING SIGN

Gum hypertrophy due to leukaemic infiltration of the gingivae is a frequent
finding.
PROGNOSIS
The prognosis of leukemia depends upon the type of leukemia
that is present and the age and health status of the patient.
Mortality (death) rates for leukemia are higher in the elderly
than in younger adults and children. In many cases, leukemia
can be managed or cured with treatments available today. In
particular, childhood ALL has a very high 5-year survival rate.
Often takes longer to achieve remission, and disease free
intervals are shorter.
AML is most malignant of all leukemia
Survival with treatment is 12-18 months
CML(Chronic myeloid leukemia): 66%
CLL(Chronic lymphocytic leukemia): 83%
AML(Acute myeloid leukemia): 27% overall, 64% for children
and teens younger than 15
ALL(Acute lymphocytic leukemia): 71% overall, over 90% for
children
TREATMENT

• TREATMENT OF ANAEMIA AND

HEMORRHAGE.
– Anemia and hemorrhage are managed by
fresh blood transfusions and platelet
concentrates.
– Patients with severe thrombocytopenia
(platelet count below 20,000/μl) require
regular platelet transfusions
-hemorrhage is an important cause of
death in these cases
• TREATMENT AND PROPHYLAXIS OF
INFECTION
TREATMENT
Chemotherapy. Chemotherapy is the major form of treatment for
leukemia. This drug treatment uses chemicals to kill leukemia cells.
Depending on the type of leukemia you have, you may receive a single
drug or a combination of drugs. These drugs may come in a pill form, or
they may be injected directly into a vein.

Biological therapy. Biological therapy works by using treatments that

help your immune system recognize and attack leukemia cells.

Targeted therapy. Targeted therapy uses drugs that attack specific

vulnerabilities within your cancer cells.
For example, the drug imatinib (Gleevec) stops the action of a protein
within the leukemia cells of people with chronic myelogenous
leukemia. This can help control the disease.

Radiation therapy. Radiation therapy uses X-rays or other high-energy

beams to damage leukemia cells and stop their growth. During
radiation therapy, you lie on a table while a large machine moves
around you, directing the radiation to precise points on your body.
TREATMENT
 BONE MARROW TRANSPLANTATION
 – Bone marrow (or stem cell) transplantation
from suitable allogenic or autologous donor
 – The basic principle of marrow transplantation
is to reconstitute the patient’s haematopoietic
system after total body irradiation and intensive
chemotherapy– kill the remaining leukemic cell
 – Bone marrow transplantation has resulted in
cure in about half the cases
NCP

1. Risk for Infection

Place in a private room. Limit visitors as indicated. Prohibit live plants
or flowers. Restrict fresh fruits and make sure they are properly
washed or peeled. Coordinate patient care so that leukemic patient
doesn’t come in contact with staff who also care for patients with
infections or infectious diseases.
Require good hand washing protocol for all personnel and visitors.
Closely monitor temperature. Note correlation between temperature
elevations and chemotherapy treatments. Observe for fever
associated with tachycardia, hypotension, subtle mental changes.
Encourage frequent turning and deep breathing.
Auscultate breath sounds, noting crackles, rhonchi. Inspect
secretions for changes in characteristics: increased sputum
production or change in sputum color. Observe urine for signs of
infection: cloudy, foul-smelling, or presence of urgency or burning
with voids.
Inspect skin for tender, erythematous areas; open wounds. Cleanse
skin with antibacterial solutions.
 2. Risk for Deficient Fluid Volume
Monitor I&O. Calculate insensible losses and
fluid balance. Note decreased urine output in
presence of adequate intake. Measure
specific gravity and urine pH.
Weigh daily.
Provide adequate nutrition.
Evaluate skin turgor, capillary refill, and
general condition of mucous membranes.
Provide adequate hydration, and a high-
residue diet, stool softners, and mild laxatives.
Encourage walking.
Administer IV fluids as indicated.
 3. Acute Pain
Investigate reports of pain. Note changes in degree (use scale
of 0–10) and site.
Provide quiet environment and reduce stressful stimuli. Limit
or reduce noise, lighting, constant interruptions.
Place in position of comfort and support joints, extremities with
pillows or padding.
Reposition periodically and assist with gentle ROM exercises.
Provide comfort measures (massage, cool packs) and
psychological support, encouragement, or presence.
Encourage use of stress management techniques. Teach
relaxation and deep-breathing exercises, guided imagery,
visualization.
Administer medication as indicated.
 4. Activity Intolerance
Evaluate reports of fatigue, noting inability to participate
in activities or ADLs.
Encourage patient to keep a diary of daily routines and
energy levels, noting activities that increase fatigue.
Provide quiet environment and uninterrupted rest
periods. Encourage rest periods before meals.
Implement energy-saving techniques (sitting, rather than
standing, use of shower chair). Assist with ambulation
and other activities as indicated.
Schedule meals around chemotherapy. Give oral hygiene
before meals and administer antimetics as indicated.
Recommend small, nutritious, high-protein meals and
snacks throughout the day.
 5. Deficient Knowledge
Review pathology of specific form of leukemia
and various treatment options.
Provide psychological support by establishing a
trusting relationship to promote
communication. Allow the patient and family to
discuss or verbalize their anger and
depression. Let the family participate in patient
care as much as possible.
 DIFFERENCE
BETWEEN
LYMPHOCYTIC
AND
MYELOID
Acute versus chronic
 Cell maturity
 Acute: clonal proliferation of immature
hematopoietic cells (the formation of blood or blood
cells )
 Chronic: mature forms of WBC; onset is more
gradual
Nature of disease onset
Acute lymphocytic Chronic lymphocytic Acute Myeloid Leukemia Chronic Myeloid Leukemia

also called acute the most common the myeloid stem cells (also called CML or
lymphoblastic leukemia, leukemia in adults. It's a usually become a type of chronic granulocytic
is a cancer that starts type of cancer that starts immature white blood cell leukemia) is a slowly
from the early version of in cells that become called myeloblasts (or progressing blood and
white blood cells called certain white blood cells myeloid blasts). The bone marrow disease that
lymphocytes in the bone (called lymphocytes) in myeloblasts in AML are usually occurs during or
marrow (the soft inner the bone marrow. The abnormal and do not after middle age, and
part of the bones, where cancer (leukemia) cells become healthy white rarely occurs in children.
new blood cells are start in the bone marrow blood cells. Sometimes in And is a disease in which
made). Leukemia cells but then go into the AML, too many stem cells the bone marrow makes
usually invade the blood blood. become abnormal red too many white blood
fairly quickly. blood cells or platelets. cells. Most people with
These abnormal white CML have a gene
blood cells, red blood mutation (change) called
cells, or platelets are also the Philadelphia
called leukemia cells or chromosome.
blasts.