leukemia kuliah

8/3/2019 Leukemia Kuliah

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Leukimia Definition: group of malignant diseases of

bone marrow

Unregulated growth of hematopoietic cells

Malignant cells replace normal cells in bone

marrow

Malignant cells may invade other tissues andorgans (lymph nodes, spleen, liver, nervous

system, GI tract, testes, skin and gingiva)


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Internal and External Stressors Although cause is unknown, theories about

related factors include:

Chromosomal abnormalities

Ionizing radiation

Exposure to chemicals and drugs (including

chemotherapy drugs) Viral infection


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Types of Leukimia

Classified according to type of stem cellabnormality that predominates in WBC

Myeloid leukimia Lymphocytic leukimia

Also divided into acute and chronic forms of thedisease

AML (acute myeloid leukimia) CML (chronic myeloid leukimia)

ALL (acute lymphocytic leukimia)

CLL (chronic lymphocytic leukimia)


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ALL L1 (Case 2.4)ALL L1 (Case 2.4)

Bone Marrow, May Giemsa Stain x 1000)


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LEUKEMIA

Dr. I B Mudita, SpA


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AML M1 (Case 6.3)AML M1 (Case 6.3)

Blood , May Giemsa x 1000


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CLL (Case 2.2)CLL (Case 2.2)

Blood, May Giemsa x 1000


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CML (Case 2.2)CML (Case 2.2)

Bone Marrow, May Giemsa x 400


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Diagnostic Data Diagnosis made on basis of abnormal CBC with

differential

The total WBC can be normal, low or extremely hightherefore the differential is essential to determine the %

of abnormal cells

For example: Patient with leukimia can have a normal WBC of

9000, but it may be composed of 10% neutrophils (only 900),

60% of blast cells (immature myeloid cell) and 30% other

WBCs. This patient is at high risk for infection because the

ANC or absolute neutrophil count is only 900!


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Diagnostic Data (cont.) Bone marrow aspiration is also done

Common sites: posterior iliac crest or sternum

Pre-procedure: consent signed, baseline V.S., checkbleeding and coagulation profile prior

Post-procedure: firm pressure to site to controlbleeding, V.S., assess for bleeding/infection at site

To distinguish leukemias from multiple myeloma(neoplasm of plasma cells, B-lymphocytes), aurine is done for Bence Jones protein (abnormalprotein in multiple myeloma)


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Acute vs. Chronic Leukemia AML

Multiple immature myeloblastic cells

Most common in adults

All

Multiple immature lymphoblast cells

Most common in children


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Acute vs. Chronic Leukemia CML

Multiple mature cells

Most common in adults

CLL

Multiple well differentiated lymphoblasts

Abnormal chromosome-Philadelphia

chromosome


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Symptoms of Acute and Chronic

Leukemia Acute (both AML and ALL)

Anemia

Thrombocytopenia

Recurrent infections

Fatigue/malaise

Bruising and bleeding

Bone pain


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Symptoms of Acute and Chronic

Leukemia Chronic (both CML and CLL)

Fatigue/malaise

Splenomegaly, lymphadenopathy

Weight loss

Bone pain


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Treatment of Acute Leukemia

Aggressive treatment (goal-rapid eradication ofleukemic cells in bone marrow)

Remission induction-use high doses of toxicchemotherapeutic agents

Consolidation-additional chemotherapy is used todestroy any remaining leukemic cells

Maintenance therapy-variety of different drugs but at

lower doses Intensification therapy-intensive chemotherapy is

repeated 6-12 months after remission achieved


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Treatment of Acute Leukemia

(cont.) Side effect of aggressive treatment with toxic

chemotherapeutic agents-Tumor Lysis Syndrome

(group of metabolic complications from massivecell destruction)

Hyperkalemia

Hypocalcemia

Hyperphosphatemia

Hyperuricemia (leading to renal calculi)

Treat tumor lysis syndrome: Use of vigorous IVhydration plus allopurinal (Zyloprim)


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Treatment of Chronic Leukemia

Conservative approach-no treatment if

asymtomatic

When symptoms occur, use of oral

chemotherapy, radiation of lymph nodes

Interferon used in CML


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Treatment of Leukemia

Bone marrow transplants can also be used

to treat leukemia

Autologous (self transplant)

Remove bone marrow prior to chemo

Take early stem cells (can be frozen and stored for

20 years)

Allogenic (from donor)


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Nursing Care for Client with

Leukemia Risk for infection re: neutropenia secondary to

leukemia process and/or chemotherapy

Risk for injury (bleeding) re: thrombocytopeniasecondary to leukemia process and/orchemotherapy

Impaired oral mucous membranes re: stomatitis

and mucositis Altered Nutrition (less than body req.) re:

anorexia, stomatitis, chronic nausea


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Thank you!

leukemia kuliah

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