leukemia

1. LEUKEMIA

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

3. ETIOLOGY
The exact cause is still unknown.
The risk factors include,
a) Genetic and environmental factors
b) Chromosomal changes( down syndrome)
c) Chemical agents(Eg. Benzene), chemotherapeutic agents

4. ETIOLOGY
d) Viruses (Epstein-Barr virus (EBV))
e) Radiation and chemotherapy
f) Near nuclear bomb sites
g) Family history of leukemia

5. CLASSIFICATION
1. Acute Vs chronic
2. 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. BASED ON THE TYPE OF WBC
1. Acute myelogenous leukemia(AML)
2. Acute lymphocytic leukemia(ALL)
3. Chronic myelogenous leukemia(CML)
4. Chronic lymphocytic leukemia(CLL)

9. Acute myelogenous leukemia(AML)
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(immature WBC in bone marrow).

10. Clinical manifestations
1. Fatigue
2. Weakness
3. Headache
4. Mouth sores
5. Anemia

11. Clinical manifestations
6. Fever
7. Sternal tenderness
8. Gingival hyperplasia
9. Minimal hepatosplenomegaly
10.Lymphadenopathy

12. Diagnostic findings
1. Low RBC count
2. Low Hb, Platelet
3. Low to high WBC count
4. Bone marrow aspiration marked increase in myeloblasts
(immature WBC in bone marrow)

13. Acute lymphocytic leukemia(ALL)
Most common type of leukemia in children.
Peak incidence between 2 and 9 years of age and in
older adults.
Immature lymphocytes proliferate in the bone marrow.

14. Clinical manifestations
1. Fever
2. Pallor
3. Anorexia
4. Fatigue and weakness

15. Clinical manifestations
5. Bone, joint and abdominal pain
6. Lymphadenopathy
7. Weight loss
8. Hepatosplenomegaly
9. Headache
10. Mouth sores

16. Diagnostic findings
Low RBC count, Hb
Low platelet count
Low, normal or high WBC count

17. Chronic myelogenous leukemia(CML)
Accounts for 15% to 20% of all cases of leukemia.
Seen between 20 and 60 years of age.

18. Causes of CML
1. Caused by excessive development of mature neoplastic
granulocytes in the bone marrow.
2. Associated with benzene exposure and high doses of
radiation.

19. Clinical manifestations
1. No symptoms early in the disease
2. Fatigue and weakness
3. Fever
4. Sternal tenderness
5. Weight loss
6. Joint pain
7. Bone pain
8. Massive splenomegaly

20. Diagnostic findings
Low RBC count
Low Hb
Normal no of lymphocytes, normal or low no
of monocytes

21. Chronic lymphocytic leukemia(CLL)
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 .

22. Chronic lymphocytic leukemia(CLL)
Lymphocytes infiltrate bone marrow, spleen and
liver
Lymph node enlargement present
Increased incidence of infection (T cell
deficiency)

23. Clinical manifestations
1. Chronic fatigue
2. Anorexia
3. Splenomegaly and lymphadenopathy
4. Hepatomegaly
5. Fever
6. Weight loss
7. Frequent infections

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

25. Management
Chemotherapy
Corticosteroids(anti-
inflammatory drugs.
Eg. Prednisolone) and
Radiation therapy

26. Drug therapy
1. Alkylating agents : Busulfan, chlorambucil, cyclophosphamide
2. Anti tumour antibiotics : daunorubicin, doxorubicin, mitoxantrone, idarubicin
3. Anti metabolites: cytarabine, 6-mercaptopurine, methotrexate, fludarabine
4. Corticosteroids: Prednisone, betamenthasone
5. Nitrosoureas: carmustine

27. Radiation therapy
Radiation therapy uses X-Rays to damage the leukemia
cells and to stop their growth.

28. Stem cell transplantation
it is a procedure to
replace diseased bone
marrow with healthy
bone marrow.

29. Nursing management
1. Assess the general condition of the patient.
2. Closely monitor the lab values .
3. Maintain good IPR with the patient.
4. Provide psychological support.
5. Instruct the patient to have a well balanced diet.
6. Monitor vital signs.

30. Nursing management
7. Include family members also in providing care
8. Explain the side effects of chemotherapy and radiation therapy
9. Administer antibiotics
10. Maintain aseptic techniques while doing the procedures
11. Proper isolation of the patient
12. Provide health education to the patient