Leukemia is a cancer of the blood and bone marrow that results in abnormal blood cell production and accumulation. The main types are acute myeloid leukemia, acute lymphoblastic leukemia, chronic myeloid leukemia, and chronic lymphocytic leukemia. Risk factors include genetic predispositions, environmental exposures, and prior chemotherapy or radiation therapy. Treatment involves chemotherapy, corticosteroids, radiation therapy, stem cell transplantation, targeted therapy, or biological therapy to destroy leukemia cells and restore normal blood cell production. Nursing care focuses on managing side effects, preventing infections, providing education and support, and monitoring the patient's condition and response to treatment.

1. RATHEESH R.L

2. Group of malignant disorders affecting
the blood and blood forming tissues of
the bone marrow, lymph system and
spleen
OR
Leukemia is a cancer of blood forming
cells in the bone marrow.

3. The exact cause is still unknown
The risk factors include,
 Genetic and environmental factors
 Chromosomal changes( down syndrome)
 Chemical agents, chemotherapeutic
agents

4.  Viruses
 Radiation and chemotherapy
 Immunologic deficiencies
 near nuclear bomb sites
 Family history of leukemia

5. Acute Vs chronic
Based on the type of WBC involved

6. Acute leukemia
Characterized by proliferation of
immature hematopoietic cells.
The bone marrow will not produce
healthy blood cells.
Immediate treatment is required to
avoid rapid progression

7. Chronic leukemia
 Involve more mature forms of WBC and
the disease onset is more gradual
 The cells are produced at a higher rate than
the normal, resulting in many abnormal
white cells in the blood.
 Mostly occurs among old people

8. Acute myelogenous leukemia(AML)
Acute lymphocytic leukemia(ALL)
Chronic myelogenous leukemia(CML)
Chronic lymphocytic leukemia(CLL)

9.  Represents only one fourth of all leukemias
 Onset is abrupt
 Increase in incidence with advancing age,
peak incidence between 60 and 70 years of
age
 Characterized by uncontrolled proliferation of
myeloblasts( precursor of basophils and
esnophils)

10.  Clinical manifestations
 Fatigue
 Weakness
 Headache
 Mouth sores
 Anemia
 Fever
 Sternal tenderness
 Gingival hyperplasia
 Minimal hepatosplenomegaly
 Lymphadenopathy

11. Diagnostic findings
Low RBC count
Low Hb, Hct, Platelet
Low to high WBC count with
myeloblasts
Bone marrow aspiration
marked increase in myeloblasts

12. Most common type of leukemia in
children
Peak incidence between 2 and 9
years of age an in older adults
Immature lymphocytes proliferate in
the bone marrow

13.  Clinical manifestations
 Fever
 Pallor
 Anorexia
 Fatigue and weakness

14.  Bone, joint and abdominal pain
 Lymphadenopathy
 Weight loss
 Hepatosplenomegaly
 Headache
 Mouth sores

15. Neurologic manifestations( leukemic
meningitis)
Nausea, vomiting, lethargy, cranial
nerve dysfunction

16. Diagnostic findings
Low RBC count, Hb,Hct
Low platelet count
Low, normal or high WBC count
Hypercellular bone marrow with
lymphoblasts (an abnormal cell
resembling a large lymphocyte)

17.  Lymphoblasts present in the CSF
 Presence of philadelphia chromosome
(The Philadelphia
chromosome or Philadelphia translocation is a
specific genetic abnormality in chromosome 22
in case of leukemia cancer cells)

18.  Accounts for 15% to 20% of all cases of
leukemia
 Associated with benzene exposure and
high doses of radiation
 Seen between 20 and 60 years of age

19.  Caused by excessive development of mature
neoplastic granulocytes(a white blood cell with
secretory granules in its cytoplasm, e.g. an
eosinophil or a basophil) in the bone marrow
 Excessive neoplastic granulocytes in the
peripheral blood infiltrate liver and spleen

20. Cells contains philadelphia
chromosome(serves as the disease
marker)
Results from the translocation of
genetic material between
chromosomes 9 and 22
It has a chronic stable phase,
followed by the development of a
more acute, aggressive phase
referred to a the blastic phase

21.  Clinical manifestations
 No symptoms early in the disease
 Fatigue and weakness
 Fever
 Sternal tenderness
 Weight loss
 Joint pain
 Bone pain
 Massive splenomegaly

22.  Diagnostic findings
 Low RBC count
 Low Hb, Hct
 Normal no of lymphocytes, normal or low
no of monocytes
 Presence of philadelphia chromosome

23. Common leukemia in adults
Seen between 50 to 70 years of age
Characterized by the production and
accumulation of functionally
inactive but long lived small mature
appearing lymphocytes

24.  Lymphocytes infiltrate bone marrow,
spleen and liver
 Lymph node enlargement present
 Increased incidence of infection (T cell
deficiency)

25. Clinical manifestations
Chronic fatigue
Anorexia
Splenomegaly and
lymphadenopathy
Hepatomegaly
Fever
Weight loss
Frequent infections

26. Diagnostic findings
Mild anemia and thrombocytopenia
with disease progression
Total WBC count > 100,000|micro
litre
Increase in peripheral lymphocytes
Increase in the presence of
lymphocytes in bone marrow

27. Chemotherapy
First stage : Induction therapy (
attempt to induce or bring about a
remission)
Second stage: post induction or post
remission chemotherapy
* intensification
* consolidation
* maintenance therapy

28.  Seeks to destroy leukemic cells in the
tissues, peripheral blood and bone
marrow in order to restore normal
hematopoiesis
 Chemotherapeutic agents cytarabine
and anti tumour antibiotics(
daunorubicin, doxorubicin, idaribicin)

29. Intensification therapy
Given immediately after induction
therapy for several months
Includes the same drugs as those
used in induction but at higher
dosages

30.  Consolidation therapy
 Started after a remission is achieved
 Consists of one or two additional courses
of the same drugs given during induction
or involve high dose therapy
 Purpose eliminate remaining
leukemic cells that may or may not be
clinically evident

31. Maintenance therapy
Treatment with lower doses of the
same drugs used in induction or
other drugs given every 3 to 4 weeks
for a prolonged period of time

32.  In addition to chemotherapy,
corticosteroids and radiation therapy are
used
 Total body radiation used to prepare a
patient for bone marrow transplantation
 In ALL prophylactic intrathecal
methotrexate or cytarabine ( given to
decrease the chance of CNS involvement)
 CNS leukemia cranial radiation

33.  Alkylating agents : Busulfan, chlorambucil,
cyclophosphamide
 Anti tumour antibiotics : daunorubicin, doxorubicin,
mitoxantrone, idarubicin
 Anti metabolites: cytarabine, 6-mercaptopurine,
methotrexate, fludarabine
 Corticosteroids: Prednisone, betamenthasone
 Nitrosoureas: carmustine
 Mitotic inhibitors: vincristine, vinblastine

34.  BIOLOGICAL THERAPY
it is used to help the immune
system to recognize and attack leukemia cells.
Eg: Rituximab, Gemtuzumab ozogamicin

35.  TARGETTED THERAPY:
In targetted therapy uses drugs
that attacks the specific vulnerabilities with in
cancer cells.
Eg: imatinib

36.  RADIATION THERAPY
radiation therapy uses X-Rays or other
high energy beams to damage the leukemia
cells and to stop their growth.

37.  STEM CELL TRANSPLANTATION
it is a procedure to replace diseased
bone marrow with healthy bone marrow.

38.  Assess the general condition of the patient
 Closely monitor the lab values
 Maintain good IPR with the patient
 Provide psychological support
 Instruct the patient to have a well balanced
diet
 Monitor vital signs

39.  Include family members also in providing
care
 Explain the side effects of chemotherapy and
radiation therapy
 Administer antibiotics
 Maintain aseptic techniques while doing the
procedures
 Proper isolation of the patient
 Provide health education to the patient

40.  Imbalanced nutrition less than body requirement
related to inadequate nutritional intake and
anorexia
 Activity intolerance related to weakness and
imbalance between oxygen supply and demand
 Impaired oral mucous membrane related to low
platelet count

41.  Ineffective therapeutic regimen management
related to lack of knowledge of disease
process, activity and medication
 Risk for infection related to bone marrow
depression