Leukemia

Leukemia
 Leukemia is a type of cancer of
the blood or bone marrow characterized
by an abnormal increase of
immature white blood cells called "blasts".
Leukemia is a broad term covering a
spectrum of diseases.
 Leukemia
 A group of malignant disorders affecting
the blood and blood-forming tissues of
 Bone marrow
 Lymph system
 Spleen
 Occurs in all age groups

8/12/2009 4
Leukemia

 Results in an accumulation of
dysfunctional cells because of a loss of
regulation in cell division
 Fatal if untreated
 Progressive
 Often thought of as a childhood disease
 The number of adults affected with
leukemia is 10 times that of children

5
 Leukemia
Etiology and Pathophysiology
 No single causative agent
 Most from a combination of factors
 Genetic and environmental influences
 Associated with the development of
leukemia
 Chemical agents
 Chemotherapeutic agents
 Viruses
 Radiation
8/12/2009
 Immunologic deficiencies 9
 Leukemia
Classification
 Acute versus chronic
Acute leukemia is characterized by a rapid increase
in the number of immature blood cells. Crowding due
to such cells makes the bone marrow unable to
produce healthy blood cells. Immediate treatment is
required in acute leukemia 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. Acute forms of leukemia
are the most common forms of leukemia in children.

8/12/2009 10
 Chronic leukemia is characterized by the
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, resulting in many abnormal
white blood cells. Whereas acute leukemia must be
treated immediately, chronic forms are sometimes
monitored for some time before treatment to ensure
maximum effectiveness of therapy. Chronic leukemia
mostly occurs in older people, but can theoretically
occur in any age group.
 Additionally, the diseases are subdivided according to
which kind of blood cell is affected. This split divides
leukemias into lymphoblastic or lymphocytic
leukemias and myeloid or myelogenous leukemias:
 In 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.
 In 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.
 Classification of leukaemia

1. 1. Acute lymphatic leukaemia (ALL)

Usually occurs before 14 years of age peak
incidence is between 2-9 years of age, older
adult

Pathophysiology
It arises from a single lymphoid stem cell, with
impaired maturation and accumulation of
the malignant cells in the bone marrow.
Acute lymphatic leukaemia Cont.
Signs and symptoms
Anaemia, bleeding, lymphadenopathy, infection
CLINICAL MANIFESTATION CLINICAL MANIFESTATION

Fever Generalized
Pallor lymphadenopathy
Bleeding Infection of respiratory tract
Anorexia Anaemia and bleeding of
Fatigue mucus membrane
Weakness Ecchymoses(discoloration of the
Bone, joint and abdominal skin resulting from bleeding
underneath)
pain
Weight loss
Increase intracranial press.
Hepatomegaly
Mouth sore
Acute lymphatic leukaemia Cont.
Management
Diagnosis
 Low RBCs count, Hb, Hct, low platelet count ,
high WBC count.
 Blood smear show immature lymph blasts.

Treatment
Chemotherapeutic agent, it involve three phases
1. Induction: Using vincristine and prednisone.

2. Consolidation: Using modified course of

intensive therapy to eradicate any remaining.
3. Maintenance
Acute lymphatic leukaemia Cont.

Treatment Cont.
 Prophylactic treatment of the CNS ,
intrathecal administration and /or
craniospinal radiation with eradicate
leukemic cells.

 Eat diet that contains high in protein,

fibres and fluids.
Acute lymphatic leukaemia Cont.
Treatment Cont.
 Avoid infection (hand washing, avoid
crowds),injury

 Take measure to decrease nausea and

to promote appetite, smoking and
spicy and hot foods.

 Maintain oral hygiene.

2. Acute Myelogenous Leukaemia (AML)
It occurs at any age but occurs most often at
adolescence and after age of 55
Pathophysiology
Characterized by the development of immature
myeloblasts in the bone marrow.
Clinical manifestation
Similar to ALL plus sternal tenderness.
Management
Diagnosis
Low RBC, Hb, Hct, low platelet count, low to high
WBC count with myeloblasts.
Acute Myelogenous Leukaemia (AML) Cont.
Treatment
 Use of cytarabine, 6-thioquanine, and
doxorubic
 The same care of client as All, plus give
adequate amounts of fluids(2000 to 3000
ml per day.)
 Instruct client about medication, effects,
side effects and nursing measures
3. Chronic lymphocytic Leukaemia (CLL)

The incidence of CLl increases with age and is

rare under the age of 35.It is common in men.
Pathophysiology
 It is characterized by proliferation of small,
abnormal , mature B lymphocytes, often leading
to decreased synthesis of immunoglobulin and
depressed antibody response.
 The number of mature lymphocytes in peripheral
blood smear and bone marrow are greatly
increased
Chronic lymphocytic Leukaemia (CLL) Cont
Clinical Manifestation
Usually there is no symptoms.
Chronic fatigue , weakness , anorexia, splenomegaly
, lymphadenopathy, hepatomegaly.
Signs and Symptoms
 Pruritic vesicular skin lesions .

 Anaemia

 Thrombocytopenia.

 The WBC count is elevated to a level between

20,000 to 100,000.
 Increase blood viscosity and clotting episode.
Chronic lymphocytic Leukaemia (CLL) Cont

Management
I. Persons are treated only when symptoms,
particular anaemia , thrombocytopenia ,
enlarged lymph nodes and spleen appear.

I. Chemotherapy agents such as chlorambucil ,

and the glucocorticoids.

I. Client and family education is that describe

for AML.
4. Chronic Myelogenous Leukaemia(CML)
Occurs between 25-60 years of age. Peak 45
year
It is caused by benzene exposure and high
doses of radiation.
Clinical Manifestation
 There is no symptoms in disease. The classic
symptoms of chronic types of leukaemia,
include:
 Fatigue, weakness, fever, sternal tenderness.

 Weight loss, joint & bone pain.

Chronic Myelogenous Leukaemia(CML)
Cont.

Clinical Manifestation Cont.

 Massive splenomegaly and increase in
sweating.
 The accelerated phase of disease(blostic
phase) is characterized by increasing
number of granulocytes in the peripheral
blood.
 There is a corresponding anaemia and
thrombocytopenia.
Chronic Myelogenous Leukaemia(CML)
Cont.
Management
Diagnosis
Lower RBC count, Hb, Hct, high platelet count
early, lower count later.
Normal number of lymphocytes and normal or
low number of monocytes in WBC differential.
Treatment
The commonly drugs are hydroxyurea and
busulfan (monitor of WBC count needed with
therapy).
Chronic Myelogenous Leukaemia(CML)
Cont.
Treatment Cont.
The only potential curative therapy of CML is
the bone marrow transplant.
Nursing Intervention
Taking measures to prevent infection.
Promoting safety.
Providing oral hygiene.
Preventing fatigue.
Promoting effective coping.
Client and family education.
5- Lymphedema Cont.
Clinical Manifestation
 Lymphedema of the lower extremities
begin with mild swelling at the ankle
which gradually extend to the entire
limb.

 Initially, the oedema is soft and

pitting, but it progresses to firm,
rubbery, non- pitting oedema.
Diagnosis

 Physical exam. Your doctor will look for physical

signs of leukemia, such as pale skin from anemia
and swelling of your lymph nodes, liver and
spleen.
 Blood tests. Abnormal levels of white blood cells
or platelets — which may suggest leukemia.
 Bone marrow test. Remove a sample of bone
marrow from your hipbone. The bone marrow is
removed using a long, thin needle. The sample is
sent to a laboratory to look for leukemia cells.
Thank You