LEUKEMIA IN ENGLISH

                                               

                                            LEUKEMIA  IN ENGLISH

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LEUKEMIA-

            Leukemia is defined neoplastic proliferation of any one type of blood cell mainly granulocyte, monocyte or lymphocyte. The defect originates in the hematopoietic stem cell, the myeloid, or the lymphoid stem cell. In other words we can say that leukemia is an unregulated proliferation of leukocytes in the bone marrow or blood cancer.

CLASSIFICATION OF LEUKEMIA-

            The leukemias are commonly classified according to the stem cell line involved, either lymphoid or myeloid. They are further classified as either acute or chronic.

ACUTE  MYELOID LEUKEMIA-

            Acute Myeloid Leukemia results from a defect in the hematopoietic stem cell that differentiates into all myeloid cells: monocytes, granulocytes (neutrophils, basophils, eosinophils), erythrocytes, and platelets.

            In prognosis is Patient’s age is a significant factor. Patients who are younger may survive for more years  after diagnosis of AML

CLINICAL MANIFESTATIONS OF AML-

Ø  Due to proliferation of abnormal cells, production of normal blood cells is reduced that results in following clinical manifestations-

Ø   Fever as infection due to neutropenia

Ø   weakness and fatigue due to anemia, and

Ø  bleeding tendencies (GI, pulmonary, and intracranial bleedings are more common) due to thrombocytopenia.

Ø  Petechiae and purpura on lower extremities to thrombocytopenia

Ø  Pain from an enlarged liver or spleen.

Ø  Pain in gums

Ø  Bone pain due to expansion of marrow.

Ø  Complications of AML include bleeding and infection, the major causes of death.

TREATMENT OF AML-

            Treatment of AML includes aggressive administration of chemotherapy. It is also called as induction therapy. It usually requires hospitalization for several weeks. Induction therapy typically involves high doses of cytarabine and daunorubicin  or mitoxantrone   or idarubicin. The aim of induction therapy is to eradicate the leukemic cells. 

            Supportive treatment consists of-

             administering blood products ( RBCs and platelets)

            promptly treating infections.

            The use of granulocytic growth factors, either G-CSF  or GM-CSF  can stimulate the bone marrow to produce normal leukocytes more quickly.

            Another treatment option is Bone Marrow Transplant or Peripheral Blood Stem Cell Transplant.

CHRONIC MYELOID LEUKEMIA-

            Chronic Myeloid Leukemia is caused by a mutation in the myeloid stem cell. In this type of leukemia Normal myeloid cells continue to be produced, but there is a  increase in the production of abnormal cells. In 90% to 95% of patients with CML, a section of DNA is missing from chromosome 22.

CLINICAL MANIFESTATIONS  OF  CML-

            Due to uncontrolled proliferation of cells, the marrow expands into the cavities of long bones (eg, the femur), and cells are also formed in the liver and spleen (extramedullary hematopoiesis), resulting in enlargement of these organs and later become painful. Other symptoms includes shortness of breath, confusion, malaise, anorexia, and weight loss

TREATMENT OF CML-

            Treatment of CML includes An oral formulation of a tyrosine kinase inhibitor, imatinib mesylate. Imatinib therapy appears to be most useful in the chronic phase of the illness. Another treatment option is Bone Marrow Transplant or Peripheral Blood Stem Cell Transplant.

ACUTE LYMPHOID LEUKEMIA-

            Acute Lymphoid Leukemia or Acute Lymphocytic Leukemia is caused by an uncontrolled proliferation of immature cells (lymphoblasts) from the lymphoid stem cell. B lymphocyte ALL found in approximately 75% of  cases and T-lymphocyte ALL occurs in approximately 25% of cases. ALL is most common in young children

CLINICAL MANIFESTATIONS  OF  ALL-

Ø  Due to uncontrolled proliferation of immature cells, the production of normal cells decreases which results in clinical manifestations such as

Ø  pain from an enlarged liver or spleen and bone pain.

Ø  The central nervous system involvement may result in headache and vomiting .

TREATMENT OF ALL-

            Treatment of ALL includes preventive cranial irradiation or intrathecal chemotherapy with methotrexate, Because ALL frequently invades the central nervous system. Systemic chemotherapy involves use of anthracyclines along with corticosteroids. Another treatment option is Bone Marrow Transplant or Peripheral Blood Stem Cell Transplant.

CHRONIC LYMPHOID  LEUKEMIA-

            Chronic Lymphoid Leukemia or chronic Lymphocytic Leukemia is common in older people. It is mainly a malignancy of B lymphocyte, T lymphocyte involvement is rare. In contrast to the acute forms of lymphoid leukemia, most of the leukemia cells in CLL are fully mature.

CLINICAL MANIFESTATIONS  OF  CLL-

Ø  Most patients of CLL are asymptomatic. Sign and symptoms includes-

Ø  fever,

Ø  Drenching sweats (especially at night),

Ø  Unintentional weight loss.

Ø  Life-threatening infections

Ø  painful lymphadenopathy

 TREATMENT OF CLL-

            Treatment of CLL includes the chemotherapy agents such as fludarabine  and cyclophosphamide which are often given in combination with the monoclonal antibody rituximab. Bacterial infections are common in patients with CLL, and IV treatment with immunoglobulin may be given to selected patients with recurrent infection.

DIAGNOSITIC  INVESTIGATIONS-

Ø  History and Physical examination. (presence of clinical manifestations of leukemias)

Ø  In all types of leukemias blood investigations are very important for diagnosis such as

Ø  Complete blood count

Ø  Bone marrow biopsy for confirming the diagnosis and type of leukemia.

NURSING MANAGEMENT-

Ø  Proper assessment is done by health history and physical examination and a nursing care plan is prepared.

Ø  Closely monitor the client for signs  of bleeding and take steps to control bleeding if it occurs.

Ø  Apply direct pressure to control  bleeding.

Ø  For epistaxis, position patient in high Fowler’s position, apply ice pack to back of neck and direct pressure to nose.

Ø  Notify physician for prolonged bleeding (eg, unable to stop within 10 minutes).

Ø  Administer platelets, fresh-frozen plasma, packed red blood cells, as prescribed.

Ø  All medications are given as prescribed and the patient’s response is and recorded in nurses notes.

Ø  The patient should be encouraged to discuss and to participate in the management of leukemia and ask their concerns.

Ø  Fatigue is a very common  symptom of  leukemia. Nursing interventions should focus on assisting the patient to establish a balance between activity and rest.

Ø  Use of a high-efficiency particulate air (HEPA) filter mask can permit the patient to ambulate outside the room despite severe neutropenia and  risk  for  infection.

Ø  Patients should be encouraged to sit up in a chair while awake rather than staying in bed; even this simple activity can improve the patient’s tidal volume and enhance circulation.

Ø  Intake and output need to be measured accurately, and daily weights should also be monitored. The patient should be assessed for signs of dehydration as well as fluid overload.

Ø  The patient should be encouraged to do as much as possible to preserve mobility and function as well as self-esteem, he should be encouraged  to maintain personal hygiene, himself.

Ø  The patient and family need to have a clear understanding of the disease, the prognosis, and how to monitor for complications or recurrence.  The nurse ensures that this information is provided.

Ø   the  nurse  should respect the patient’s choices about treatment, including measures to prolong life and other end-of-life measures.

Ø  Being diagnosed with  leukemia can be extremely frightening. Providing emotional support and discussing the uncertain future are crucial to alleviate anxiety.

Ø  During discharge planning and health education  patient and family should focus on the disease, its treatment, home care and certainly the resulting significant risk of infection and follow up care.