Leukemia

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1. leukemia RATHEESH R.L

2. definition 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. etiology 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. classification Acute Vs chronic Based on the type of WBC involved

6. Acute vs chronic 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 Acute myelogenous leukemia(AML) Acute lymphocytic leukemia(ALL) Chronic myelogenous leukemia(CML) Chronic lymphocytic leukemia(CLL)

9. Acute myelogenous leukemia 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. Acute myelogenous leukemia Clinical manifestations Fatigue Weakness Headache Mouth sores Anemia Fever Sternal tenderness Gingival hyperplasia Minimal hepatosplenomegaly Lymphadenopathy

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

12. Acute lymphocytic leukemia 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. Acute lymphocytic leukemia…. Clinical manifestations Fever Pallor Anorexia Fatigue and weakness

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

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

16. Acute lymphocytic leukemia…. 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. Chronic myelogenous leukemia 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. Chronic myelogenous leukemia.. 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. Chronic myelogenous leukemia.. Clinical manifestations No symptoms early in the disease Fatigue and weakness Fever Sternal tenderness Weight loss Joint pain Bone pain Massive splenomegaly

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

23. Chronic lymphocytic leukemia 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. Chronic lymphocytic leukemia.. Clinical manifestations Chronic fatigue Anorexia Splenomegaly and lymphadenopathy Hepatomegaly Fever Weight loss Frequent infections

26. Chronic lymphocytic leukemia.. 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. management 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. Induction therapy 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. post induction chemotherapy Intensification therapy Given immediately after induction therapy for several months Includes the same drugs as those used in induction but at higher dosages

30. post induction chemotherapy.. 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. post induction chemotherapy.. 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. Management…. 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. Drug therapy 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. NURSING MANAGEMENT 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. Nursing diagnosis 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. Nursing diagnosis Ineffective therapeutic regimen management related to lack of knowledge of disease process, activity and medication Risk for infection related to bone marrow depression