Cancer of the blood: Leukemia

• Leukemia is a primary disorder of the bone marrow in which the normal elements are replaced with abnormal white blood cells. (Unrestricted proliferation of immature white blood cells). Leukemia is the most common form of childhood cancer.

• Lymphoid cells grow and develop into lymphocytes. • Myeloid cells grow and develop into red blood cells,

granulocytes, monocytes, and platelets • Leukemia may develop at any time during the usual

stages of normal lymphoid or myeloid development. Leukemia may be classified as acute or chronic, lymphocytic or myelogenous.

• Acute leukemias are rapidly progressive diseases affecting the undifferentiated or immature cells, production of an excessive number of immature (still in the stem, or ―blast,‖ stage) white blood cells (WBCs); the result is cells without normal function.

• Chronic leukemias progress more slowly, permitting maturation and differentiation of cells so that they retain some of their normal function.

Types of Childhood Leukemia

• Acute leukemia account for about 95% of all cases of leukemia in children and adolescents including 3 types:

• ALL – Acute Lymphoblastic Leukemia• AML – Acute Myeloid Leukemia• CML – Chronic Myeloid Leukemia

Etiology• Exact cause is NOT known• Genetics

– Identical twin with leukemia– Chromosome abnormalities

• Down Syndrome– Other

• Severe Combined Immunodeficiency• Neurofibromatosis

• Environmental– Ionizing Radiation– Chemotherapy– Viruses– Pesticides

Complications

metastasis to the blood, bone, CNS, spleen, liver, or

other organs and alterations in growth. Late effects

include problems with neurocognitive function and

ocular, cardiovascular, or thyroid dysfunction.

With advances in treatment over the past 50 years,

most cases of childhood leukemia are curable, while

children who experience relapse or present with

advanced disease have a poorer prognosis.

Other complications

• Infection/Sepsis• Thrombosis• Hemorrhage / DIC• Leukostasis

Clinical Manifestation• Cold that does not resolve completely. • Pallor, fatigue, listlessness, irritability, nausea

or vomiting and anorexia may be noted. • Fever (may be persistent or recurrent, with

unknown cause). • Recurrent infection. • Unusual bleeding or bruising. • Abdominal and bone pain and headache

Diagnosis• Leukemia confirmed by bone marrow aspiration or

biopsy. • Lumbar puncture will reveal whether leukemic cells

have infiltrated the CNS. • Liver function tests and blood urea nitrogen (BUN)

and creatinine levels determine liver and renal function.

• Chest x-ray may reveal pneumonia or a mediastinal mass.

• Chest CT scan and bone scans to detect metastasis to lung.

Bone marrow

Normal Leukemic (ALL)

Therapeutic management• Therapeutic management of the child with ALL

focuses on giving chemotherapy to eradicate the leukemic cells, restore normal bone marrow function and decrease CNS invasion.

• Chemotherapy medications don’t cross the blood brain barrier, so to prevent leukemic cells from going to CNS, combination of oral and intrathecal medications (as Methotrexate) is needed, injection of medication in CSF by L.P.

• Bone marrow transplantation

Nursing Interventions

• Preventing infection • Promoting comfort

• Family and child care: • Preparation of family, child for diagnostic procedure e.g.

L.P, bone marrow. • Provide emotional support to child and family (improves

coping abilities). • Actively listen to the child’s and family’s concerns

(validates their feelings, establishes trust). • Provide open communication with the child and siblings;

children appreciate honesty about their illness, and coping is improved.

• Refer families to community resources such as parent support groups and grief counseling (such support improves coping abilities).