Moreno, Bryan Angelo A.

MAN 212 – Patho-Physiological Concepts

LEUKEMIA

➢ It is a cancer of one class of white blood cells in the bone marrow, which results in
the proliferation of that cell type to the exclusion of other types.

➢ Leukemia appears to be a clonal disorder, meaning one abnormal cancerous cell

proliferates without control, producing an abnormal group of daughter cells.

Types of Leukemia:

1. Acute Leukemia:
✓ Affect younger age group frequently
✓ Rapid course and the peripheral blood and bone marrow show the presence
of large number of blast cells.
✓ If left untreated, these are fatal within weeks/ months.

2. Chronic Leukemia:
✓ Generally, affect older people
✓ Onset is insidious
✓ Usually less aggressive
✓ The cells involved are usually more mature cells
✓ Terminate life within 2-3 yrs. of onset.

❖ Leukemia is described as acute or chronic, depending on the suddenness of

appearance and how well differentiated the cancerous cells are.

Four basic types of Leukemia:

Acute Myelocytic Leukemia (AML) - (includes myeloblastic, promyelocytic,

monocytic, myelomonocytic, erythrocytic, and megakaryocytic)

Acute Lymphocytic Leukemia (ALL) - (includes T cell, B cell, and Null cell)

Chronic Myelocytic Leukemia (CML) - (includes myelocytic and myelomonocytic)

Chronic Lymphocytic Leukemia (CLL) - (includes plasmocytic {multiple myeloma},

Hairy cell, prolymphocytic, large granular cell lymphocytic, Sezary’s syndrome, and
circulating lymphoma)

Epidemiology:

Recent epidemiologic studies have focused on international variations, secular

trends, genetic syndromes, familial aggregation, chromosomal abnormalities,
environmental exposures, and unique subgroups defined either demographically or
biologically.

Etiology:
♦ Genetic
♦ Radiation
♦ Toxic chemical exposure
♦ Medication (Alkylating-agents, Topoisomerase-II inhibitors,
Chloramphenicol, Phenylbutazone, Chloroquine)
♦ Primary immunodeficiency and infection

Pathophysiology:

Risk Factors:

→ Genetic predisposition coupled with a known or unknown initiator (mutating) event

 → Siblings of children with leukemia.
→ Individuals with certain chromosomal abnormalities, including Down Syndrome
→ Exposure to radiation, some drugs that depress the bone marrow and various
chemotherapeutic agents
→ Environmental agents such as pesticides and certain viral infections
→ Previous illness with a variety of diseases associated with hematopoiesis (blood
cell production). These diseases include Hodgkin lymphoma, multiple myeloma,
polycythemia Vera, sideroblastic anemia, and myelodysplastic.

Clinical Manifestations:

Acute leukemia has marked clinical manifestations. Chronic leukemia progresses

slowly and may have few symptoms until advanced.

• Pallor and fatigue from anemia

• Frequent infections caused by a decrease in white blood cells.
• Bleeding and bruising caused by thrombocytopenia and coagulation disorders.
• Bone pain caused by accumulation of cells in the marrow, which leads to
increased pressure and cell death. Bone pain related to leukemia is usually
progressive.
• Weight loss
• Lymphadenopathy, splenomegaly, and hepatomegaly

Diagnostic Tests/Tools:

➢ History and physical examination

➢ Blood examination
➢ Peripheral blood examination
➢ Chest x-ray
➢ Bone marrow biopsy
➢ Flow cytometry (analyzes blood or bone marrow cells to determine whether a
high white cell count is the result of blood cancer)
➢ Cerebral spinal fluid examination

Treatment:

Medical Interventions:

▪ Multiple drug chemotherapy

▪ Antibiotics
▪ Anthocyanins (chemicals with known antioxidant and liver protecting properties)
▪ Chemotherapeutic Agents:
Induction Therapy – seeks to destroy leukemic cells in the tissues,
peripheral blood, bone marrow (vincristine and prednisone)
Intensification Therapy - given after induction therapy, same drugs at
higher dose and/or other drugs.
 Consolidation Therapy - started after remission is achieved, eliminate
remaining leukemic cells that may not be evident
Maintenance Therapy - lower doses of the same drug

Surgical Interventions:

▪ Transfusions of red blood cells and platelets to reverse anemia and prevent
bleeding.
▪ Bone Marrow Transplant
▪ Stem Cell Transplantation

Nursing Interventions:

▪ Eat diet that contains high in protein, fiber and fluid (2000 to 3000 ml/day)
▪ Avoid infection (hand washing, avoid crowds)
▪ Take measure to decrease nausea and to promote appetite, smoking, spicy and
hot foods
▪ Maintain oral hygiene
▪ Instruct client and family about medication, effects, side effects and nursing
measures.