LEUKEMIA

Dr. C.REVATHI, M.Sc(N)., Ph.D.(N).,

Principal, Manjari Devi School & College of Nursing
Bhubaneswar, Odisha.
LEUKEMIA

It is a malignant
disease of a blood
forming organs. The
common feature of
leukemia is an
unregulated
proliferation of white
blood cells (WBCs)
in the bone marrow.
CLASSIFICATION OF
LEUKEMIA
BY HOW QUICKLY THE DISEASE DEVELOPS:-

Chronic: -
leukemia cells come from mature, abnormal
cells. The cells Grow vigorously

Acute: -
leukemia develops from early cells, called
"blasts". Blasts are young cells that divide
frequently. They target immature cells.
BY THE TYPE OF BLOOD CELL THAT IS AFFECTED:-

Lymphoid cells: -
leukemia begins from white blood cells
called lymphocytes.

Myeloid cells:-
leukemia involves the other 3 commontypes
of white blood cells known asgranulocytes.
They are neutrophils, eosinophils, or
basophils.
ETIOLOGY AND RISK
FACTORS OF
LUEKEMIA
• Gender: Men are more likely to develop than
women.
• Age: typically increases with age.
• Family history: First degree relatives and an
identical twin who has increases risk.
• Genetic diseases: Down syndrome may play a
role in the development of leukemia.
• Smoking: increase the risk of developing AML.
EXPOSURES:
• Exposure to high levels of radiation: e.g.
atomic bomb explosions and Chemical
exposure: Long-term exposure to certain
pesticides

PREVIOUS TREATMENT:
• Previous cancer treatment: Certain types of
chemotherapy and radiation therapy for other
cancers are considered leukemia risk factors.
 SIGN AND
SYMPTOMS OF
LEUKEMIA
Fever, chills, and other flu-like symptoms.

Weakness and fatigue.

Frequent infections.

Loss of appetite/weight.

Swollen or tender lymph nodes, liver, or spleen.

Tiny red spots under the skin.

Swollen or bleeding gums.

Sweating, especially at night; and/or Bone

or joint pain.

Easy bleeding or bruising.

DIAGNOSTICS
TESTS
CBC with Manual Differential

Low or high white blood cells, varying levels of

neutropenia

Thrombocytopenia present in 85 % ofcases

Peripheral smear- malignant cells

Low haemoglobin, less than 9.0

Elevated ( ESR)

Uric acid level- Can be elevated or high LIPID

PCR (polymerase chain reaction) -Presence of biomarkers in

blood/ bone marrow cells. DNA abnormality marker with
AML or CML “philadelphia chromosome”

Liver Function Tests- Elevation due to inflammation of liver

C-Reactive Protein - Elevation

BIOPSY
• BONE MARROWASPIRATION:
The doctor uses a thick, hollow needle to remove
samples of bone marrow.

• BONE MARROWBIOPSY:
The doctor uses a very thick, hollow needle to
remove a small piece of bone and bone marrow.
CHEST X-RAY
An X-ray can show swollen lymph nodes or other
signs of disease in your chest.
 MEDICAL
MANAGEMENT
 ACUTE LEUKEMIA
Chemotherapy: - A different way of giving chemotherapy
called intrathecal chemotherapy treats these areas by
injecting the drugs directly into your spinal canal to attack
any leukemia cells.

Radiation Therapy:-Radiation therapy uses high doses of

radiation, such as X-rays, to destroy cancer cells.

Stem cell transplant: - Donated cells from a "matched"

donor can rebuild your supply of normal blood cells.
CHRONIC LEUKEMIA
Chemotherapy – Chemotherapy is the use of medicines
that attack cancer cells. Many medicines are available
to fight leukemia and help you livelonger.

SURGERY - If the spleen starts destroying red blood

cells and platelets, it may need to be removed. This
operation is called a splenectomy.
Nursing Assessment:
• Obtain health history, focusing on fatigue, weight loss,
night sweats, and activity intolerance.
• Assess for signs of bleeding & infection.
• Evaluate splenomegaly, lymphodenopathy &
hepatomegaly.
• As difficulty in swallowing, coughing, rectal pain.
• Examine patient for enlargement of lymph nodes,
hepato splenomegaly, evidence of bleeding, abnormal
breathing sounds, skin lesions.
• Inspect the patient for the sign of infection & the
incidence of frequency of infection.
Nursing Diagnosis:
Impaired tissue integrity related to high dose radiation
therapy.
Risk for infection to decreased neutrophils, altered response to
microbial invasion, and presence of environmental pathogens.
Impaired oral mucous membrane related to low platelet counts
and/or effects of pathologic conditions & treatment as evidenced
by oral bleeding & blood-filled bullae.

Risk for injury related to low platelet counts & treatment.

Acute pain related to tumor growth, infection oradverse

effects of chemotherapy.
Activity intolerance related to anemia & adverse effectof
chemotherapy.
To maintain tissueintegrity:
• Avoid rubbing powders, deodorants, lotions or
ointments (unless prescribed) or application of
heat & cold to treated areas.
• Encourage the patient to keep the treated area
clean & dry.
• Advise the patient to bath the area gently with
tepid water & mild soap.
• Encourage the patient to wear loose fitting cloths.
• Advise the patient to protect skin from over&
direct exposure to sun light, chlorine &
temperature extremes.
To prevent from infection:
• Inspect the patient for the sign & symptoms of
infection e.g. redness etc.
• Maintain asepsis for patient at risk.
• Instruct the patient to take antibioticsas prescribed
by doctor to prevent microbial resistance.
• Teach the patient & family how to avoid infections e.g.
about personal hygiene technique of hand washing,
oral care, skin hygiene etc.
• Educate the patient to report if there is any presence
of signs of infection to the doctorimmediately.
• Monitor granulocyte count & WBC count to identify the
presence of infection.
• Screen all visitors for communicable diseases.
To free the mucosa without bleeding:
• Monitor lips, tongue, mucous membrane, tonsillar
fossae & gums for moisture, color, texture, presence
of debris & infection.
• Assist the patient to select soft, bland, & non acidic
foods to decrease irritation of oral mucosa.
• Advise the patient to use soft toothbrush forremoval
of dental debris.
• Instruct the patient to perform oral hygiene after
eating & as often as needed toavoid breakdown of
oral mucosa.
• Advise the patient to avoid the use of lemon-glycerine
swabs to prevent excessive drying of the mucosa.
To reduce the risk for injury:
• Monitor the patient for the sign & symptoms of persistent
bleeding to detect internal bleeding.
• Monitor for the prothrombin time (PT), partial
thromboplastin time (PTT), fibrinogen, fibrin degradation
products & platelet count to determine bleedingrisk.
• Protect the patient from trauma that may cause bleeding
to reduce tissue trauma & subsequent bleeding in tissue.
• Administer blood products (e.g. platelets, fresh frozen
plasma) to replace coagulation factor.
• Teach patient to avoid aspirin or other anticoagulants to
prevent additional bleeding risk.
• Educate the patient about the harm of injury to patient as
well as to family member.
To reduce pain:
• Assess the frequency of pain & administer analgesicson
regular schedule, as patient monitored for adverse effects.
• Provide comfortable position to the patient to promote
comfort of the patient.
• Advise the patient for the use of non-pharmacologic
methods, music therapy, relaxation, distraction & imagery
to help to manage pain.
• Provide calm environment to patient to promote physical
comfort of the patient.
• Provide diversional therapy to patient to divert the mind of
patient from pain.
• Provide psychological support to patient.
• Advise the patient to restrict that activity which generates
pain.
THANKYOU