Leukaemia
Background A and P
Neoplastic disorders
of the leukopoietic tissue, (spleen, lymphatic tissue, bone marrow)
Widespread
proliferation within these tissues of immature precursors of one of the types
of leucocytes.
Aetiology
Exposure to
radiation, (eg. twenty fold increase
in survivors from
Chemical carcinogens,
eg. benzene
? Virus
Genetic
abnormalities, eg. more common in
Cytotoxic therapy
Heredity
Types
Acute or chronic
Lymphatic, (lymphocytes, accounts for 95
% of childhood cases)
Myeloid, (Granulocytes,
95% of adult cases).
Monocytic, (monocytes)
Acute
In acute all three
present much the same picture
General malaise
Increased BMR,
tachycardia, weight loss
Pain from bones,
(arthralgia)
Pain from spleen from
swelling or infarct
May occur at any age,
most - common children, boys > girls.
Recurrent infective
lesions
Purpera
Fever
Sore throat
Haemorrhagic
problems, (thrombocytopaenia) such as bleeding from the mouth, possible
cerebral involvement.
Possible cerebral
involvement from leukaemic infiltration
White cell count up,
red cell and platelets down.
Splenomegally and
lymphadenopathy.
Eruptions in the skin
due to leukaemic infiltration.
Chronic Myeloid
Insidious onset
Early to middle adult
life, men > women.
Tiredness due to
Anaemia
Splenomegaly
Dragging sensation
from splenomegaly.
Priapism
High white count
Chronic Lymphatic
Insidious onset
Men of late middle
age.
Tiredness due to
anaemia.
Hepatomegaly
Diagnosis
Leukocytosis, white
cell count 20 000 - 100 000, 90% of
which are blast cells, eg. lymphoblasts, myeloblasts or monoblasts
Bone marrow biopsy,
large numbers of immature cells
Lymph node biopsy
Radiology
Management
Chemotherapy,
(cytotoxic).
DXT
Bone marrow
transplantation
Antibiotics,
analgesics, antiemetics.
Bed rest, tired and
listless.
Blood component
replacement.
Obtain baseline
information, TPR BP weight, blood tests.
Monitoring of toxic
manifestations during chemotherapy,
Observation for side
effects, eg. mouth ulcers, hair loss, peripheral neuropathy, constipation, bone
marrow depression, cardiac involvement, -
Also steroids may be
given.
Care of
IVI/indwelling central line
Observation for
haemorrhage
Observation for
infection, the main cause of morbidity and
mortality, early recognition
Monitor bloods
Cultures of blood,
urine, sputum etc.
CXR, possible isotope
scan.
Broad spectrum
prophylaxis.
Look-out for fungal
infections.
Laminar air flow
Reduce sources of environmental contamination,
handwashing, minimal contacts etc.
Involve patient in
treatment.
ADLs as indicated,
gentle handling.
Allow for patient
denial.
Allow for patient and
relative anger and other affective reactions.
3-4 l day fluids to
prevent UTI and precipitation of uric acid
crystals from breakdown of blood cells by antilukeamic agents.
Control fever.
Pay special attention
to mouth care, antiseptic/analgesic mouth wash.
Nutrition relative to
metabolic demands.
Patient Education.
Avoid outside and
self infective possibilities.
Maintain good
nutrition.
Monitor weight.
Get dental advice,
oral hygiene after each meal.
Avoid rectal mucosa
trauma from constipation.
Regular personal
hygiene.
Avoid antiperspirant
which may block sweat ducts.
Avoid bleeding, eg.
trauma, aspirin.
Oral contraception,
(possible haemorrhagic complications).
Leukaemia may be
treated.