LEUKEMIA CASE STUDY- SOAP FORMAT

A BRIEF OVERVIEW ABOUT LEUKEMIA AND CASE PRESENTATION OF LEUKEMIA IN SOAP FORMAT.

1. LEUKEMIA. PRESENTED BY: VARSHA WADNERE(PD328)

2. LEUKEMIA - It is a group of malignant disorder affecting the blood and blood forming tissues of bone marrow lymph system and spleen .

3. Common treatments used to fight leukemia include: Chemotherapy - Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells. Depending on the type of leukemia you have, you may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein. Biological therapy- Biological therapy works by using treatments that help your immune system recognize and attack leukemia cells. Targeted therapy. Targeted therapy uses drugs that attack specific vulnerabilities within your cancer cells. For example, the drug IMATINIB stops the action of a protein within the leukemia cells of people with CML. This can help control the disease. Radiation therapy- Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. During radiation therapy, you lie on a table while a large machine moves around you, directing the radiation to precise points on your body. You may receive radiation in one specific area of your body where there is a collection of leukemia cells, or you may receive radiation over your whole body. Radiation therapy may be used to prepare for a stem cell transplant. Stem cell transplant- A stem cell transplant is a procedure to replace your diseased bone marrow with healthy bone marrow. Before a stem cell transplant, you receive high doses of chemotherapy or radiation therapy to destroy your diseased bone marrow. Then you receive an infusion of blood-forming stem cells that help to rebuild your bone marrow. You may receive stem cells from a donor, or in some cases you may be able to use your own stem cells. A stem cell transplant is very similar to a bone marrow transplant.

4. SOAP ANALYSIS. PATIENT DETAILS. Name- Raghavendra Deenanath Age-15Yrs Sex-Male D.O.A-2/12/2011

5. SUBJECTIVE DATA. 1. Fever since 2months. 2. Pain in Throat from10 days with difficulty in respiration.

6. OBJECTIVE DATA. Air entry is decreased in bilateral lung. Petechiae spots, splinter hemorrhages, bilateral conjunctival hemorrhage present. Swelling around neck, tongue, lips, face, epiglottis. Modified mallaampatti -Grade 3. Oral mucosa is edematous with bluish discoloration .

7. ASSESSMENT. PROVISIONAL DIAGNOSIS- ACUTE LYMPHOID LEUKEMIA(ALL) L2 TYPE. FINAL DIAGNOSIS- ACUTE LYMPHOID LEUKEMIA L2 TYPE.

8. HISTORY. NO SERIOUS OR ANY KIND OF COMPLICATED HISTORY TO CAUSE ALL. For fever Paracetamol was given.

9. GOALS OF TREATMENT.

10. ASSESSMENT OF CURRENT THERAPY. 1. GENERAL MANAGEMENT- The increased white cell mass may be reduced by leukophoresis. Frequent blood transfusions to maintain Hb levels at 7g/dL. Platelet transfusions are required if counts remain <10 t20,000 or if <50,000 and remaining symptomatic or undergoing an invasive procedure. Give FFP and other blood products as needed. Neutropenia management, including protective isolation, appropriate antibiotic therapy, granulocyte-colony stimulating factor. GVHD is managed by supportive treatment and parenteral nutrition. PGE1 and immunosuppression may be helpful. Psychological support for both patient and family is vital. 2. AIRWAY MANAGEMENT. 3. DRUG THERAPY.

11. 1) PREDNISONE. Indication - Anti-inflammatory glucocorticoid used for autoimmune and inflammatory diseases. MOA- suppress the immune system by reducing activity and volume of lymphatic system. ADR- mood swings, vertigo, cardiac failure. Interaction- increase effect of Ach inhibitors, cyclosporine. Contraindication- peptic ulcer, chicken pox. 2) MERCAPTOPURINE. Indication- Antineoplastic agent used for acute lymphocytic leukemia. MOA- DNA and RNA synthesis. ADR- anorexia, diarrhea, pancreatitis. Interaction- warfarin, allopurinol. Contraindication- hypersensitivity.

12. 3) VINCRISTINE. Indication- antitumor vinca alkaloid used for acute lymphocytic leukemia. MOA- Binds with tubulin and inhibits microtubule formation arrest cell at metaphase by disrupting mitotic spindle. ADR- alopecia, oral ulcers, paraesthesia. Interaction- digoxin, verapamil. Contraindication- Charcot-Marie tooth syndrome. 4)L-ASPARGINASE. Indication- used for acute lymphocytic leukemia. MOA- reduce asparagine level which stops leukemic cells DNA synthesis. ADR- confusion, abdominal cramps, chills. Interaction- Vincristine neurotoxicity. Contraindication- thrombosis, pancreatitis.

13. PLANNING. MONITOR SYMPTOMS OF PATIENT. MONITOR DRUG INTERACTIONS AND ADR.

14. POINT TO PHYSICIAN. L-Asparaginase interact with Vincristine so instead of that Cyclophosphamide or Methotrexate may be given .

15. POINT TO PATIENT. As a patient, your responsibilities include: Choosing a Caregiver Preventing Infection Healthy Living Your Surroundings & Environment

16. REFERENCES. https://www.slideshare.net/rosesrred90/acute-lymphoid-leukemia-case-presentation?from_m_app=android

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