Case Analysis:
LEUKEMIA
Leukemia:
Leukemia is a cancer of the body’s blood-forming tissues, including the bone
marrow and the lymphatic system.
There are many types of leukemia that exists. Some forms of leukemia are more
common in children. Other forms of leukemia occur mostly in adults.
Leukemia:
In general, leukemia is thought to occur when some blood cells acquire mutations in
their DNA – the instructions inside each cell that guide its action. There may be
other changes in the cells that have yet to be fully understand that could contribute to
leukemia.
Classifications of Leukemia
Doctors classify leukemia based on its speed of progression and the type of cells
involved.
Acute Leukemia Chronic Leukemia
In acute leukemia, the abnormal cells are There are many types of chronic leukemia. Some
immature blood cells (blasts). They can’t produce too many cells and some cause too few
carry out their normal functions, and they cells to be produced. Chronic leukemia involves
multiply rapidly, so the disease worsens more mature blood cells. These blood cells replicate
quickly. Acute leukemia requires aggressive, and accumulate more slowly and can function
timely treatment. normally for a period of time. Some forms of
chronic leukemia initially produce no early
symptoms and can go unnoticed or undiagnosed for
years.
Classifications of Leukemia
The second type of classification is by type of white blood cell affected:
Lymphocytic Leukemia Myelogenous Leukemia
This type of leukemia affects the lymphoid This type of leukemia affects the myeloid cells.
cells (lymphocytes), which form lymphoid or Myeloid cells gives rise to red blood cells, white
lymphatic tissue. Lymphatic tissue makes up blood cells and platelet-producing cells.
your immune system. (WBC only) (RBC,WBC,platelets etc.)
Differences in leukemias
Acute Leukemias are usually found more in children and adolescents up to 16 years
of age.
ALL (acute lymphoblastic leukemia)
Most common leukemias that are usually found more in older adults with rates
peaking in the seventh, eighth, and ninth decades of life.
CLL (chronic lymphocytic leukemia)
AML (acute myeloid leukemia)
Symptoms of Leukemia
The initial symptoms of lymphocytic and myelogenous leukemia includes:
Fever
Fatigue
Night sweats
Swollen lymph nodes in the neck, under the arms, or in the groin area.
Frequent infections
Weight loss
Metastasis:
Leukemia starts in the soft, inner part of the bones (bone marrow) but often moves
quickly into the blood. It can then spread to other parts of the body, such as the
lymph nodes, spleen, liver, CNS, and other organs.
Causes of Leukemia
While the exact causes of leukemia is not known, risk factors have been identified,
including:
Radiation exposure
Certain chemotherapy for cancer
Smoking
Family history of leukemia
Exposure to certain chemicals such as benzene
Diagnosis
Physical exam. Your doctor will look for physical signs of leukemia, such as pale skin from anemia,
swelling of your lymph nodes, and enlargement of your liver and spleen.
Blood tests. By looking at a sample of your blood, your doctor can determine if you have abnormal
levels of red or white blood cells or platelets — which may suggest leukemia.
Bone marrow test. Your doctor may recommend a procedure to 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. Specialized tests of your leukemia cells may reveal certain
characteristics that are used to determine your treatment options.
Diagnosis
Bone marrow exam
Diagnosis
CBC
Normal Leukemia
RBC 4.5 x 106 cells/uL ↓ - anemia
Hemoglobin M: 13.5 -17.5 g/dL ↓
F: 12.0 – 15.5 g/dL
Hematocrit M: 39 – 50 g/dL ↓
F: 35 – 45 g/dL
Platelets 150,000 – 450,000 cell/uL ↓ - Thrombocytopenia
WBC 3,500 – 10,500 cell/uL ↓ - Leukopenia
Treatment:
Treatment for your leukemia depends on many factors. Your doctor determines your leukemia
treatment options based on your age and overall health, the type of leukemia you have, and whether it
has spread to other parts of your body, including the central nervous system.
Common treatments include:
Chemotherapy
Biological therapy
Targeted therapy
Radiation therapy
Stem cell transplant
NCP
Assessment Diagnosis Planning Intervention Rationale Evaluation
Objective: Risk for infection After 8 hours of
related to inadequate nursing interventions • Place patient in a • To protect patient
• Irritability primary defenses. the patient will identify private room. from potential
• Pallor of skin and actions to prevent or Limit visitors as sources of
mucous reduce the risk of indicated. pathogens or
membranes infection. infection.
• Prevents cross-
• Require good hand contamination and
washing protocol reduce risk of
for all personnel infection
and visitors.
• Encourage • Prevents stasis of
frequent turning respiratory
and deep secretions and
breathing. reducing risk of
atelectasis or
pneumonia.
NCP
Assessment Diagnosis Planning Intervention Rationale Evaluation
• Inspect skin for • May indicate local
tender, infection.
erythematous
areas, and open
wounds. Cleanse
skin with
antibacterial
solutions.
• Administer
antibiotic as • To treat specific
indicated. infections.
Nursing Diagnosis:
Risk for infection
Risk for deficient fluid volume
Activity intolerance
Deficient knowledge
Acute Pain
