LEUKEMIA (oncological disorder) in children

1. GOVERNENT COLLEGE OF NURSING
G.R.M.C. , GWALIOR (M.P.)
PRESENTATION ON: ONCOLOGICAL DISORDER
(LEUKEMIA)
PRESENTED BY-
NEHA SAHNI
M. SC. NURSING FINAL YEAR
CHILD HEALTH NURSING

2. LEUKEMIA

3. DEFINITION
Leukemia is defined as uncontrolled neoplastic
proliferation of leucocyte precursors.

4. INCIDENCE
 It is the most common malignancy of children less than 15 years of
age.
 The peak incidence is at 4 years of age.
 Incidence in Males is greater than in females.
 It is more common in white than black children.

5. ETIOLOGICAL FACTORS
 The exact cause is unknown.
 Viruses like human papilloma virus and Epstein-Barr views.
 Radiations.
 Exposure to chemicals & dings like benzene & Dilantin
 Familial predisposition
 Chromosomal abnormalities.

6. CLASSIFICATION
LUEKEMIA
Acute chronic
Acute lymphoid acute myeloid chronic lymphoid chronic myeloid
Leukemia (80%) leukemia (10-20%) leukemia (absent in children) leukemia (2-3%)
T-cell B-cell Pre B-cell Null cell
acute myeloblastic acute promyelocytic acute myelomonocytic acute monocytic acute erythrocytic

7. PATHOPHYSIOLOGY
Uncontrolled proliferation of leukocyte precursors
Competition for nutrients, infiltration of organs & replacement of normal cells by leukemic cells
Bone marrow dysfunction Reticuloendothelial system Central nervous system Generalized hypermetabolism
RBCs WBC Platelets Enlarged liver, lymph Leukemic meningitis cellular starvation
nodes & spleen
Anaemia Infection Haemorrhage

8. ACUTE LYMPHOID LEUKEMIA
 It is the most commonly diagnosed cancer in children, which
accounts for 80% of all childhood leukemias.
 Risk Factors: viruses, radiation, exposure to certain toxic
chemicals & drugs predisposition.

9. • TYPES :

10. ACUTE NONLYMPHOID LEUKEMIA /
ACUTE MYELOID LEUKEMIA
 Acute Myeloid leukemia/Acute nonlymphocytic leukemias is abnormal
proliferation of monocytes and myelocytes in bone marrow.
 It is present in15% children with leukemia is affected with leukemia
 It has a poor prognosis

11. • TYPES :

12. CLINICAL FEATURES OF AML
 Recurrent chronic infections
 Fatigue
 lymphadenopathy
 Hepatosplenomegaly
 Bone or joint pain
 Pallor
 Frequent Bruising
 CNS :- headache, blurred vision, fundal hemorrhage & paresis.
 Thrombocytopenia
 Loss of appetite & weight loss’
 Vomiting
 Coughing
 Shortness of Breath.
 Weakness
 fever

13. DIAGNOSTIC EVALUATION
 History & Physical Examination
 Peripheral Blood smear test
 Bone Marrow Examination.
 Blood investigation for elevated Serum uric acid level.
 LFT & RFT
 CBC
 Lumbar Puncture.
 Cytomorphologic, cytochemical & Immunologic studies.
 Radiologic studies.

14. MANAGEMENT

15. PHASES OF CHEMOTHERAPY

16.  INDUCTION PHASE
 This is the phase that reduces leukemic cells to an undetectable level.
 It is also known as Remission phase.
 In remission, there is no evidence of leukemia on physical examination, bone marrow evaluation,
peripheral blood smear, CSF examination or examination of extramedullary sites.
 About 95% children with leukemia achieve remission during induction, with in 4 weeks.
 Drugs used for induction in ALL are:-
• Prednisolone
• vincristine
• L-asparaginase with or without doxorubicin.
 Drugs used for induction in AML are:-
• cytarabine (Ara-c)
• daunorubicin

17.  CONSOLIDATION PHASE
 It is the second phase of treatment.
 It aims at eradicating any residual leukemic cell.
 This phase of therapy begins once remission is attained.
 This phase involves prophylactic treatment of CNS with cranial irradiation and or intrathecal
administration of methotrexate.
 The therapy usually consists of daily high-dose radiation for about 2
weeks or twice a week doses of methotrexate, a total of 5-6 injections.

18.  MAINTENANCE THERAPY
 It aims at reducing the no. of leukemic cells;
 Maintenance therapy begins after successful completion of induction and
consolidation phase.
 Drugs used in Maintenance therapy are:-
• 6-mercaptopurine & weekly doses of oral methotrexate.
 During this phase weekly or monthly CBC is done to evaluate marrow’s response
to drugs.
 If WBC count goes below 2,000/mm³ or toxic side effects occur, then therapy is
temporarily stopped or dose is reduced.

19. BONE MARROW TRANSPLANTATION
 This procedure is successful in treating some children with ALL and AML.
 Bone Marrow Transplantation generally is not recommended for children with
ALL because of excellent results possible with chemotherapy.
 Bone Marrow Transplantation is only possible when suitable donor is
available.
 Prognosis after transplantation depends on type of leukemia .
 Long-term survival after marrow transplantation is seen in 20-50% cases.

20. CHRONIC MYELOID LEUKEMIA
 It affects Myeloid cells and usually grows slowly at first.
 There is increase no. of WBC’s.
 Age of onset: 25 to 60 years of age , peak incidence around 45 years
of age.

21. CHRONIC LYMPHOCYTIC LEUKEMIA
 It affects lymphoid cells and usually grows slowly.
 There is an increase no. Of WBC’s.
 Age of onset: 50 to 70 years , rare below 30 years of age.

22. NURSING CARE PLAN FOR LEUKEMIA
NURSING DIAGNOSIS
1) Risk for infection related to invasive Procedure.
2) Risk for deficient fluid volume related to vomiting, hemorrhage, diarrhea.
3) Acute pain related to enlarged lymph nodes and Psychological manifestation.
4) Activity intolerance related to generalized weakness and therapeutic restrictions.
5) Deficient knowledge related to disease condition.