Definition

It is a group of malignant
disorder, affecting the blood
and
blood –forming tissue of the bone
marrow lymph system and
spleen.
The word Leukemia comes from
the Greek leukos which means
"white" and aima which
means "blood".
The stem cells are committed to
produce specific types of blood
cells. Lymphoid stem cells
produce either T or B
lymphocytes.
Myeloid stem cells differentiate
into three broad cell types:
RBCs, WBCs, and platelets.
 Function of the bone marrow
The bone marrow is found in the inside of
bones. The marrow in the large bones of
adults produces blood cells. Approximately
4% of our total bodyweight consists of
bone marrow.

There are two types of bone marrow:

 1. Red marrow, made up mainly of
myeloid tissue.
2. Yellow marrow, made up mostly of fat
cells.
Red marrow can be found in the flat
bones, such as the breast
bone, skull, vertebrae, shoulder blades,
hip bone and ribs. Red marrow can
also be found at the ends of long
bones, such as the humerus and
femur.
 White blood cells (lymphocytes), red blood
cells and platelets are produced in the red
marrow. Red blood cells carry oxygen, white
blood cells fight diseases. Platelets are
essential for blood clotting.
•  Yellow marrow can be found in the inside
of the middle section of long bones.
White blood cells, which help to body fight
infection.
Red blood cells, which carry oxygen to
all parts of the body.
Platelets, which help in blood clot.
If a person loses a lot of blood the body
can convert yellow marrow to red marrow
in order to raise blood cell production.
 Leukemia
Definition
It is a group of malignant
disorder, affecting the blood and blood
–forming tissue of the bone
marrow lymph system and spleen.
etiology
Combination of predisposing
factors including genetic and
environmental influences.
Chronic exposure to chemical such
as benzene
Radiation exposure.
Cytotoxic therapy of breast, lung
and testicular cancer.
Congenital anomaly
The presence of primary
immunodeficiency and infection
with the human T –cell
leukemia virus type-1
PATHOPHYSIOLOG
Y
The lack of control causes –
nomal bone marrow to be replaced by
immature and undifferentiated
leukocytes or blat cells . –
abnormal immature leukocytes then
circulates in the blood and
infiltrate the blood forming organs
( liver
, spleen, lymph nodes) and other sites
throughout the body.
 Different types of leukemia

It may be acute or chronic.

Acute leukemia gets worse very
fast and may make feel sick
right away.
Chronic leukemia gets worse slowly
and may not cause symptoms for
years.
Lymphocytic and Myelogenous
Leukemias are also subdivided into
the type of affected blood cell. If
the cancerous transformation
occurs in the type of marrow that
makes lymphocytes, the disease is
called lymphocytic leukemia.
If the cancerous change occurs in
the type of marrow cells that
produce red blood cells, other types
of white
cells, and platelets, the disease is
called myelogenous leukemia
FRENCH- AMERICAN –BRITISH
(FAB) CLASSIFICATION OF
ACUTE LEUKEMIA
 INCIDENCE—
In adults, chronic lymphocytic leukemia
(CLL) and acute myelogenous
leukemia (AML) are the most common
leukemias.
In children, the most common leukemia
is acute lymphoblastic leukemia (ALL).
Childhood leukemias also include acute
myelogenous leukemia (AML) and other
myeloid leukemias, such as chronic
myelogenous leukemia (CML) and
Relate to problems caused by
Bone marrow failure
 Overcrowding by abnormal cells
 Inadequate production of
normal marrow elements
 Anemia, thrombocytopenia, ↓ number
and function of WBCs
Relate to problems caused
by Leukemic cells
infiltrate
patient’s organs
Splenomegaly

Hepatomegaly
Lymphadenopathy
Bone pain,
meningeal irritation,
 Classification of
leukaemia
1. 1. Acute lymphatic leukaemia (ALL)
Usually occurs before 14 years of age peak
incidence is between 2-9 years of age, older
adult
 Acute lymphatic leukaemia Cont.
Signs and symptoms
Anaemia, bleeding, lymphadenopathy, infection
Clinical manifestation Clinical manifestation

Fever Weakness
Pallor Bone, joint and
Bleeding abdominal
Anorexia pain
Increase intracranial
Fatigue
press.
 Generalized lymphadenopathy
 Infection of respiratory tract
 Anaemia and bleeding of
mucus membrane
 Weight lossa
 Mouth sore
 Acute lymphatic leukaemia Cont.
Diagnosis
 Low RBCs count, Hb, Hct, low platelet count ,
low normal or high WBC count.
 Blood smear show immature lymph blasts.
Treatment
Chemotherapeutic agent, it involve three phases
1. Induction: Using vincristine and prednisone.
2. Consolidation: Using modified course of
intensive therapy to eradicate any
remaining.
3. Maintenance
 Acute lymphatic leukaemia Cont.

Treatment Cont.
 Prophylactic treatment of the CNS
, intrathecal administration and /or
craniospinal radiation with
eradicate leukemic cells.

 Eat diet that contains high

in protein, fibres and fluids.
 Acute lymphatic leukaemia Cont.
Treatment Cont.
 Avoid infection (hand washing,
avoid crowds),injury

 Take measure to decrease nausea and

to promote appetite, smoking and
spicy and hot foods.

 Maintain oral hygiene.

ALL Histology
 (AML)
It occurs at any age but occurs most often
at adolescence and after age of 55
Pathophysiology
Characterized by the development of
immature myeloblasts in the bone marrow.
Clinical manifestation
Similar to ALL plus sternal tenderness.
Management
Diagnosis
Low RBC, Hb, Hct, low platelet count, low to
high WBC count with myeloblasts.
 Acute Myelogenous Leukaemia (AML)
Treatment Cont.
Use of cytarabine, 6-thioquanine,
and doxorubic
The same care of client as All, plus give
adequate amounts of fluids(2000 to
3000 ml per day.)
Instruct client about
medication, effects, side effects and
nursing measures
AML Histology
 Chronic lymphocytic
(CLL) Leukaemia
The incidence of CLl increases with age and is
rare under the age of 35.It is common in men.
Pathophysiology
 It is characterized by proliferation of
small, abnormal , mature B lymphocytes, often
leading to decreased synthesis of
immunoglobulin and depressed antibody
response.
The number of mature lymphocytes in
peripheral blood smear and bone marrow are
greatly increased
 Chronic lymphocytic Leukaemia (CLL) Cont
Clinical Manifestation
Usually there is no symptoms.
Chronic fatigue , weakness , anorexia,
splenomegaly
, lymphadenopathy, hepatomegaly.
Signs and Symptoms
 Pruritic vesicular skin lesions .
 Anaemia
 Thrombocytopenia.
 The WBC count is elevated to a level
between 20,000 to 100,000.

 Chronic lymphocytic Leukaemia (CLL) Cont

Management
I. Persons are treated only when symptoms,
particular anaemia , thrombocytopenia , enlarged
lymph nodes and spleen appear.

I. Chemotherapy agents such as chlorambucil ,

and the glucocorticoids.

I. Client and family education is that describe

for AML.
 Chronic
Myelogenous
Leukaemia(CML)
Philadelphia chromosome
The chromosome abnormality that
causes chronic myeloid leukemia
 Occurs between 25-60 years of age. Peak
45 year
It is caused by benzene exposure and
high doses of radiation .
Clinical Manifestation
There is no symptoms in disease. The
classic symptoms, include:
 Fatigue, weakness, fever.
 Weight loss, joint & bone pain.
 Chronic Myelogenous
Leukaemia(CML) Cont.
• Clinical Manifestation Cont.
 Massive splenomegaly
 The accelerated phase of
disease(blostic phase) is
characterized by increasing
number of granulocytes in the
peripheral blood.
 Chronic
Leukaemia(CML) Cont.
Myelogenous
Diagnosis
Lower RBC count, Hb, Hct, high
platelet count early, lower count later.
Normal number of lymphocytes and
normal or low number of monocytes in
WBC .
Treatment
The commonly drugs are hydroxyurea
and busulfan (monitor of WBC count
needed with therapy).
The only potential curative therapy of CML
is the bone marrow transplant.
Nursing Intervention
Taking measures to prevent infection.
Promoting safety.
Providing oral
hygiene. Preventing
fatigue.
Promoting effective
coping.
 MANAGEMENT

watchful waiting,
chemotherapy,
 targeted therapy,
 radiation therapy, and
stem cell transplant.
 The choice of treatment
depends mainly on the
following:
The type of leukemia (acute or chronic)
Age
 Whether leukemia cells were found in
cerebrospinal fluid
 WATCHFUL WAITING
chronic leukemia without
symptoms, may not need
cancer treatment right away.
 Watch for health closely so that
treatment can start when it begin
to have symptoms.
Not getting cancer treatment right
away is called watchful waiting.
 chemotherapy
People with acute leukemia need to be
treated right away.
The goal of treatment is to destroy
signs of leukemia in the body and
make symptoms go away. This is
called a remission.
After people go into remission, more
therapy may be given to prevent a
relapse.
 The 3
• Induction phase; the
phases of usual criteria for complete
treatment remission are 5% of the
protocols bone marrow cells and
normal peripheral blood
are; counts.
• Once remission
completes the
consolidation phase
begins.
 Consolidation phase; modified
course of intensive chemotherapy
are given to eradicate any
remaining disease. Usually a higher
dose of 1 or more chemotherapeutic
agents are administered.
 Maintainance phase; small dose of
different combination of
chemotheraptic agents are given every
3 to 4 weeks. This phase may
continue for a year or longer and is
structured to allow the client to live
as normal life as possible
 Targeted therapy

This affects only tumor cells and spare

normal cells. hence decreasing the
associated toxicities. Gemtuzumab
ozofamicin (mylotarg) is an anti
D33nmonoclonal antibody linked to
calicheamicin, which is potent
cytotoxic agent.
STEM CELL TRANSPLANT
Goal;

Totally eliminate leukemic cells from the body

using combinations of chemotherapy with
or without total body irradiation
Eradicates patient’s hematopoietic stem cells
Replaced with those of an HLA-matched
(Human Leukocyte Antigen)
Sibling (is a brother or a sister; that
is, any person who shares at least one
of the same parents )
Volunteer
Identical twin
Patient’s own stem cells removed
before
 TYPES OF STEM CELL
TRANSPLANTATION
1. Allogeneic Stem Cell Transplant
stem cells are taken from a matching
donor.
To determine if a donor’s stem cells are
the right match, the patient undergoes
a human leukocyte antigens (HLA) test.
Through this test, we compare the
patient’s blood and tissue type against
blood samples from the donor.
Donors may include:
HLA-matched relative (most often a
sibling)
HLA-matched unrelated donor
HLA miss-matched family member
Unrelated umbilical cord blood
2. Autologous Stem Cell Transplant
In this type of transplant, stem cells are
collected from the patient themselves.
The stem cells are then harvested, frozen
and stored, and then given back to the
patient. This type of transplant is rare for
leukemia patients and is typically used in
select cases of AML.
Nutrition and Physical Activity
It's important for you to take care of
eating well and staying as active.
right amount of calories to maintain a
good weight. enough protein. Eating well
may help to feel better and have more
energy.
Follow-up Care
 regular checkups after treatment
for leukemia .
NURSING MANAGEMENT
 Nursing diagnosis
1. Impaired oral mucous membrane related
to low platelet counts or effect of pathologic
conditions and treatment.
2. Ineffective therapeutic management related
to lack of knowledge of disease process,
activity and medication.
3. imbalanced nutrition less than body
requirement reated to anorexia , pain
and fatigue.
4. risk for injury related to low platelet
counts and treatment
 Overall
goals
 Understand and cooperate with the
treatment plan
Experience minimal side effects and
complications of disease and
treatment
Feel hopeful and supported during the
periods of treatment, relapse, and
remission
Many physical and psychological
Goals of rehabilitation
Manage
 Physical

 Psychosocial

 Social

 Spiritual

 Delayedeffects
Support groups