Malignant disorders affecting the blood and blood-forming tissues of the BM, lymph system and spleen
Accumulation of dysfunctional cells
Cause: unknown
Genetic
Chemical: benzene, alkylating agents
Virus, radiation
Classification:
Cell maturity, onset, type of leukocyte involved
Acute: immature WBC, rapid
Chronic: more mature forms of WBC, onset gradual
Acute lymphocytic leukemia (ALL):
Acute myelogenous leukemia (AML)
Chronic myelogenous (grnulocytic) leukemia (CML)
Chronic lymphocytic leukemia (CLL)
Acute Myelogenous Leukemia (AML)
Uncontrolled proliferation of myeloblasts (precursor of granulocytes) in the BM
Acute Lymphocytic Leukemia:
Uncontrolled proliferation of lymphocytes (B cells) in the BM
Chronic Myelogenous Leukemia (CML)
Proliferation of mature granulocytes BM
Chronic Lymphocytic Leukemia (CLL)
Proliferation of mature lymphocytes BM
Clinical manifestations:
BM overcrowded abnormal cells
Inadequate production of normal cells (anemia, thrombocytopenia, WBC)
Organ infiltration: splenomegaly, hepatomegaly, lympadenopathy,bone pain, meningeal irritation)
DX:
Peripheral blood
Bone marrow aspiration
CT: leukemic cells outside bld/BM
Leukemia
Nursing Assessment:
Anemia: weakness, pallor, dyspnea
Thrombocytopenia:petechiae,spontaneous bleed, ecchymosis
Restrict activity, observe hemorrhage
Control bleed: Ice, pressure (3-5 min),
Soft-brush, toothettes
Give bld components
Neutropenia: Infection, fever, malaise
Protective isolation (avoid crowd)
Observe S/S of infection
Inflammation inj sites
VS changes
Cough, obtain cultures
Antibiotics
Mouth care: Q 2 hrs
Nursing Management:
Chemotherapy
Induction therapy: high dose (one dose)
Intensification therapy (immediately after induction): for several months
Consolidation: remission achieved (one or 2 courses)
Maintenance: lower dose Q 3 to 4 wks
WBC > 100,000: leukapheresis and hydroxyurea
Hematopoietic Stem Cell Transplantation (HSCT)
High dose chemotherapy/irradiation
Replaced with HLA (human leukocyte antigen) stem cells
Allogeneic : sibling/donor
Syngeneic: identical twin
Autologous: self
Categories:
Nursing Management,
Oncology
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