Leukemia

Malignant disorders of blood forming tissues eg bone marrow, spleen , lymph system

Caused by uncontrolled proliferation of blood cell line(myeloid Vs lymphoid)

results in accumulation of dysfunctional cells

Causes

DNA mutations oncogenes

Chemical exposure such as benzene

Genetics

Viruses, radiation

Classification

By cell line (myeloid Vs lymphoid)

By onset ( acute Vs chronic)

Acute myelogenous leukaemia

Common in adults 80% of acute leukaemias in adults

Rapid onset

Bone marrow is overcrowded by myeloblasts

Symptoms

Infection, bleeding, fatigue

Enlarged spleen, liver ,gum , hyperplasia

Diagnostic studies

Low RBC count, low Platelets count

bone marrow high myeloblasts

Chronic myelogenous leukaemia

Mutation of myeloid stem cell

Overproduction of mature granulocytes

Often progress from chronic to accelerated then blast crisis(often mistaken as AML)

Symptoms

Often asymptomatic

Very high WBC count >100000

Spleenomegaly, fatigue, weight loss

Acute lymphocytic leukaemia

Common with children

Mostly origin of B cells

Bone marrow overcrowded by immature lymphocytes

Symptoms

Fever, fatigue, bleeding

CNS involvement like head ache , meningeal signs, vomiting

Prognosis

Very good in children lower in adults

Chronic lymphocytic leukaemia

Accumulation of functionally inactive mature B cell

Common with older adults

Symptoms

Often asymptomatic

Lymphadenopathy, spleenomegaly

B symptoms like night sweats, fever and weight loss

Treatment principles for leukaemia

Chemotherapy

Induction - aggressive therapy to obtain remission

Intensification - eliminate hidden disease

Maintenance - prevent relapse especially with ALL

Other therapies

Radiation therapy

HCST stem cell transplant

Targeted therapy depending on leukaemia type

Nursing management

Manage neutropenia, anemia and thrombocytopenia

Patient/family education

Monitor for relapse

Psychological support