SCB OLLEGE OF NURSING ,

CUTTACK

TOPIC-
LEUKEMIA

PRESENTED BY –
Suchismita Mohanty, PBBsc
Nursing
1st year, Roll no. – 54
PRESENTED TO –
Subasini Jena Mam (Tutor),
 CONTENT S
• Introduction of leukemia
• Definition of leukemia
• Incidence of leukemia
• Etiology of leukemia
• Pathophysiology of leukemia
• Types of leukemia
• Clinical manifestation
• Diagnostic evaluation
• Management
• Nursing management
• Summary
 INTRODUCTION
• Cancer of hematopoietic system are disorders that results from
proliferation of malignant cells.
• Malignant cells are originated in bone marrow, thymus and lymphatic
tissue.
• Blood cell that originate in bone marrow are called hematopoietic
cell.
• Blood cell that originate in lymph are called lymphoid cell.
• Leukemia- cancer of bone marrow
• Lymphoma – cancer of lymphoid tissue
 DEFINITION
• The word comes from Greek word Leukos- means “white”
And aima means “blood”.
• It is a group of malignant disorders, affecting the blood
and blood forming tissue of the bone marrow, lymph
system, and spleen.
 INCIDENCE
• About 3-4 per 1,00,000 population.
• These people account for 30% to 52% of all childhood
cancer in males & 19% to 52% in females.
 Function of bone marrow
• The bone marrow found inside the bones.
• About 40% of total body weight consists of bone marrow.
• There are 2types of bone marrow
• Red marrow- made up of myeloid tissue. Myeloid tissue is a
hematopoietic tissue produces RBC – for O2 transport, WBC – for
immunity, Platelets – for clotting.
• Red marrow can found in flat bones ( breast bone, skull, vertbrae,
shoulder blades hip bones)
• Red marrow also found at the end of long bones humerus and femur.
 Contd....
• Yellow marrow-:
• Mainly made up of adepocytes ( fat cells).
• Stores fat, whichserves as an energy reserve.
• Found mostly in medullary cavity of long bones
• Has fewer blood forming cell compared to red marrow.
• In case of severe blood loss Or anemia yellow marrow convert
back in to red marrow to increase blood cell production.
 ETIOLOGY
• The exact cause is unknown
• Genetic factors (Philadelphia chromosome 22)
• Congenital abnormalities like Down syndrome Trisomy 21,Trisomy 13 (patau‘s syndrome).
• Identical twins, fraternal twins and siblings of children with leukemia are also at increased
risk.
• Family history
• Diagnostic X ray
• Over exposure to ionizing radiation chemicals
• Workers exposed to chemical agents such as benzene.
• Smoking
• Use of antibiotics such as chloramphenicol leads to children leukemia
 Contd....
• Working with certain chemicals ( chemotherapy)
• The presence of primary immunodeficiency & infection
with the Human T – cell leukemia virus type -1 (HTLV-1).
PATHOPHYSIOLOGY
 TYPES
• Leukemia are usually classified according to the type of
cell involved. There are 4 major types on the basis of
acute vs chronic.
1. Acute lymphocytic leukemia.
2. Acute myelogenous leukemia
3. Chronic lymphocytic leukemia
4. Chronic myelogenous leukemia
 Acute lymphocytic leukemia
• ALL is seen mainly in children
• In this type, immature lymphocytes proliferate in bone marrow most are of B cell
origin .
• Age of onset is before 14 years of age, peak incidence is between 2-9 years of age .
• SIGN AND SYMPTOMS -:
• Fever, pale skin, bleeding, anorexia, fatigue, and weakness
• Bone, joint, abdominal pain.
• Generalized lymphanedopathy, splenomegaly, infection weight loss
• Hepatomegaly, headache, mouthsores
• Increased ICP
 Contd....
• DIAGNOSTIC EVALUATION-:
• Low RBC count, Hb, Hct, low platelet countl low or high WBC count.
• Transverse lines of rarefaction at the end of meta physis of long
bones on x rays.
• Hyper cellular bone marrow with lymphoblast.
• Lymphoblast also possible in CSF.
• Presence of Philadelphia chromosome. ( genetic abnormality in
chromosome 22).
 Contd....
TREATMENT-:
• Chemotherapeutic agent using vincristine & prednisolone.
• Prophylactic treatment of CNS ( intra thecal chemotherapy. Drug- methotrexate,
cytarabine& sometimes hydrocortisone). Given directly in to CSF via lumbarpuncturr.
• Craniospinal radiation with eradicate leukemic cells.
• Eat diet that contains high in protein fiber and fluids.
• Avoid infection ( hand washing, avoid cwowds)
• Take measures to decrease nausea and to promote appetite, smoking and spicy and
hot foods.
• Maintain oral hygiene.
 Acute myelogenous leukemia
• AML involves proliferation of myeloblasts and most common in
adults between the ages of 25 and [Link] risk gradually
increasing with age. There is hyper plasia of bone marrow.
• Age of onset – increase in incidence with advancing age, peak
incidence between 60 and 70 years of age.
• CLINICAL MANIFESTATION-: similar to ALL with sternal
tenderness.
• DIAGNOSIS -: low RBC, Hb, Hct, low platelet count, low to high
WBC count with myeloblast.
 Contd...
• TREATMENT-: use of cytarabine, 6 thioquanine, doxorubic
• Give adequate amount of fluids (2-3L/ day)
• Instruct client about medication effect, side effect.
 Chronic lymphocytic leukemia
• It is most common type in adults
• CLL involves proliferation of B lymphocytes.
• It is usually less aggressive than CML. It is most often seen in elderly.
• Age of onset -: 50-70years of age, rare below 30 years of age.
• CLINICAL MANIFESTATION-:
• Chronic fatigue, anorexia
• Splenomegaly, lymphadenopthy, hepatomegaly , may progress to
fever, night sweat weight loss.
 Contd....
• DIAGNOSTIC EVALUATION-:
• Mild anemia& thrombocytopenia with disease progression.
• Hypogammaglobulinemia
• MANAGEMENT-:
• Persons are treated only when symptoms, particular anemia,
thrombocytopenia, enlarged lymphnode and spleen appear.
• Chemotherapy agents such as chloramphenicol and the
glucocorticoids.
 CHRONIC MYELOGENOUS
LEUKEMIA
• CML Occurs at all ages. Although it’s onset in gradual, in most patients it
eventually reaches a rapidly progresaive stage similar to AML. And proves fatal.
• It is caused by an abnormality of chromosome 22.
• Occurs between 25 – 60 years of age. Peak 45 year.
• It is caused by benzene exposure and high doses of radiation.
• CLINICAL MANIFESTATION-:
• Fatigue , weakness, fever, weight loss, joint and bone pain
• Massive splenomegaly
• There is corresponding anemia and thrombocytopenia.
 Contd....
• DIAGNOSIS-:
• Lower RBC, Hb, Hct count, high platelet count early and lower
platelet count later.
• Presence of Philadelphia chromosome in 90% of patients.
• TREATMENT -:
• The commonly drugs are hydroxyurea and busulfan.
• The only potential curative therapy of CML is the bone marrow
transplant.
 NURSING MANAGEMENT
• NURSING DIAGNOSIS-: 1. Ineffective protection/ risk for infection related to neutropenia
secondary to leukemia.
• INTERVENTIONS-:
• Assess the client
• Handwashing techniques
• Client isolation
• Daily bath with antibacterial soap.
• Maintain oral hygiene
• Daily stool softners. ( to reduce anal fissure) .
• Perineal cleansing for every bowel movement.
• Avoid rectal suppositories and rectal thermometer.
• Temp should be taken every 4hrly.
 Contd...
• 2. Imbalnced nutrition less than body requirement related to anorexia, pain or
fatigue.
• INTERVENTIONS -:
• Administer anti emetics before meal/ drinking.
• Administer local IV analgesics.
• Weight daily
• Provide hygienic well balanced diet.
• Small frequent feeding should be provided
• If client cannot tolerate oral fluids for an extended period, begin TPN as ordered.
 Contd.
• 3. Fatigue related to side effects of treatmemts related
causes of fatigue.
• INTERVENTIONS-:
• Asses for anemia
• Assess for physical, mental, and tretment related causes
of fatigue.
• Encourage exercise to maintain strength.
• Allow for rest.
 Contd...
• 4. Relief from pain
• Cold sponging
• Gentle back and shoulder massage may provide comfort
• Un interrupted sleep should be provided to the patient.
• Acetaminophen is used typically to reduce fever
• Analgesic can be given.
 SUMMARY
• Leukemia is a blood cancer caused by a rise in the number
of WBC in your body.
• Those WBC crowd out the RBC and platelets that your
body needs to be healthy.
• Caused by smoke, radiation, chemotherapy, family history,
down syndrome.
• Diagnosed by blood test, bone marrow biopsy, imaging
test.
• Treatment involved radiation chemotherapeutic agents,
stem cell transplant.