LEUKEMIA (CANCER OF
BLOOD)
It is a malignant disorder of blood and blood forming tissues (bone marrow,
lymph system and spleen) characterized by a proliferation of abnormal white
blood cells in the body.
PATHOPHYSIOLOGY
Leukemia occurs as a
result of a malignant transformation of the stem cells or communited precursors
of leukocytes (white blood cells) causing bone marrow production of immature
WBCs (white blood cells) that cannot function normally. The abnormal leukocytes
proliferate rapidly by cloning instead of normal mitosis. They spread into the
circulating system where they steadily replace normally functioning WBCs.
As this occurs, the protective lymphocyte functions as well
as cellular and humeral immunity are reduced leaving the body vulnerable to
infections. Bone marrow production of normal blood cells such as RED BLOOD
CELLS (RBCs), and PLATELETS is affected resulting in anaemia (less haemoglobin
in blood), thrombocytopenia (reduction of number of platelets in
blood),leucopaenia (reduction in the number of WBCs), neutropenia (reduction in
the number of neutrophils in blood) and abnormal bleeding.
TYPES OF LEUKEMIA
 |
| types of leukemia |
There are two main types of leukemia. They are:
v
Acute leukemia
v
Chronic leukemia
ACUTE LEUKEMIA
Acute leukemia refers to proliferation of immature
haemapoietic (WBCs, RBCs and PLATELETS) cells by cloning. This results from a
malignant transformation of a particular type of leukocyte which replicates and
expands by cloning. It can be divided into the following subtypes;
v
Acute Lymphoblastic/lymphocytes
Leukemia (ALL)
This accounts for 25% of all childhood cancer and 75% of
leukemia in children. The peak age of onset of leukemia is two years. It is common in boys and
Caucasians.
v
Acute
Myelogenous Leukemia (AML)
Incidence increases with aging. It is common in adults
within 60 to 70 years of age. It affects all ethnic groups. It can affect
children. It accounts for about 85% of acute leukemia in adults. It has a
sudden onset with rapid proliferation of myeloblasts which infiltrates other
organs.
CHRONIC LEUKEMIA
In chronic leukemia more mature WBCs are affected and the
condition develops more gradually. It is rare in children. The subtypes of
chronic leukemia include;
v
Chronic
Myelogenous Leukemia/Chronic Granulocytic Leukemia
It accounts for about 15% of leukemia
cases. It affects people of ages 25 to 60 years. It is caused by excessive
development of mature neoplastic granulocytes in the bone marrow which moves
into circulation and eventually infiltrates the liver and the spleen. The
condition develops very slowly over several years.
v
Chronic
Lymphocytic Leukemia
This affects older adults 50 to 70 years
and accounts for 25% of leukemia cases, but make up about 85% of chronic
leukemia. It is characterized by quite mature but dysfunctional lymphocytes
especially B cells. The abnormal cells infiltrate the bone marrow, spleen and
liver causing generalized lymphadenopathy (disease of the lymph nodes).
v
Hairy
Cell Leukemia
This accounts for about 2% of leukemia in
adults. It usually affects males over 40 years of age. It is a chronic disease
characterized by proliferation of B lymphocytes that infiltrate the bone marrow
and the spleen. The cells have hair-like projections on microscopic
examination.
CLINICAL FEATURES
 |
| COMMON SYMPTOMS |
v
Recurrent fever
v
Headache
v
Fatigue and weakness
v
Pallor
v
Anaemia
v
Malaise
v
Anorexia
v
Joint and bone pain
v
Bleeding tendencies eg gum bleeding, rectal
bleeding
v
Enlargement of liver and spleen
v
Swollen lymph nodes
v
Frequent and unusual infections
v
Pain and tenderness in long bones
CAUSES
There is no known cause of leukemia, however it’s
predisposing factors include:
v
Genetic factors
v
Chromosomal changes/defects such as Down
Syndrome
v
Ionizing radiations
v
Chemical agents such as benzene
v
Chemotherapeutic agents eg. Alkylating agents
v
Children with immunodeficiency
v
Exposure to viruses before or after birth
v
Smoking and tobacco use
DIAGNOSTIC
INVESTIGATIONS
v
Cell Blood Count (CBC) will reveal
thrombocytopenia, neutropenia and anaemia
v
Bone marrow aspiration (biopsy) will reveal immature and abnormal
lymphoblast
v
Serum electrolytes – increased uric acid,
calcium, potassium and phosphorus
v
CT scan
v
Lumbar puncture/cerebrospinal fluid (CSF) test
for spread
v
MRI of the brain
v
Lymph node biopsy
 |
| BONE MARROW |
MANAGEMENT/MEDICAL/RADIATION/RADIOTHERAPY
Chemotherapy: this is done according to the
following stages:
·
Induction
·
Consolidation
·
Continuation
·
Treatment
During the INDUCTION phase, the patient receives
an intense course of chemotherapy that that is meant to causes a complete
remission of the disease. Complete remission occurs when the patient has less
than 5% of the bone marrow cells as blast cells and the peripheral blood counts
are normal.
Once
remission has been sustained for one month, the patient enters the CONSOLIDATION phase, during which she
or he receives a modified course of chemotherapy to eradicate any remaining
disease.
The CONTINUATION OR MAINTENANCE phase may
continue for more than a year during which time the patient receives small
doses of chemotherapy every 3 to 4 weeks.
TREATMENT of CNS leukemia is an essential
component of therapy that has replaced irradiation which leads to significant
CNS complications with intensive intrathecal and systemic chemotherapy for most
patients. Some patient also need transfusions with blood component therapy to
control infection and prevent bleeding and anemias.
Chemotherapeutic agents;
1.
Anthracycline [ idarubicin or daunorbicin] or anthracenedione [
mitoxantrone] combined for induction and remission
2.
Vincristine prednisone
Surgery
Bone marrow
transplantation [ BMT] is an option for some patients.
Early BMTS
were allogenic transplants using stem cells that had been harvested from bone
marrows
Nursing Management
Observation/observe
and document the following;
1. Response to chemotherapy or radiation
treatments
2. Emotional response to the diagnosis
of cancer or the use of reverse isolation
3. Comprehension of treatment plan,
including care; Purpose and potential side effects of radiation and
chemotherapy; bone marrow transplant
4. Presence of complications; Infection,
bleeding, poor wound healing, ineffective coping by the patient or significant
others
5. Observation and physical assessment
every 3 hours for effect of drugs and bruising
6. Monitor renal function [intake and
output and specific gravity]
7. Monitor dietary intake, vomiting and
constipation
8. Level of consciousness
Protection From Injury and Infection
1. Protect the patient from injury and
infection. To limit the risk of bleeding hold firm pressure on all puncture
wounds for at least 10 minutes or until they stop oozing.
2. Limit the use of intramuscular
injections and intravenous catheter placement when the patient is pancytopenic.
3. Avoid taking rectal temperatures,
using rectal suppositories, or performing a rectal examination.
4. Use soft tooth brushes and sponges to
prevent injury
5. Treat
pressure areas to prevent bed sores
6. Turn client 2 hourly to prevent complication related to pneumonia
7. Ensure strict asepsis during nursing
procedures such as wound dressing, drug administration feeding bathing and mouth care.
Psychological Care
1. If the patient does not respond to
treatment be honest about the patient’s prognosis.
2. Determine from parents and relatives
how much information they want to share with the client about a terminal
disease.
3. Work with the patient, significant
others, and chaplain to help the patient plan for a terminal illness and
achieve a compassionate death.
I HUMBLY ASK YOU NOT TO KEEP THIS KNOWLEDGE TO YOURSELF
ALONE, HOWEVER, SHARE ON ALL SOCIAL MEDIAS FOR YOUR FRIENDS, FAMILY MEMBERS,
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