Leukemia describes a group of malignant
disorders in which uncontrolled
proliferation of leucocyte in the bone
marrow infiltrate the blood forming
tissues of the bone marrow, lymph
system, liver and spleen.
Leukemia occurs in all age groups.
Leukemia is a malignant disease of blood
forming organs of the body that results in
uncontrolled growth of immature white
In India the incidence of leukemia's is 3-4
per 1,00,000 population.
30-52% of all childhood cancers in males
and 19-52% in females in India.
Approximately 26500 occur in adults
In general no causative agents.
Leukemias result from a combination of
genetic factors and environmental factors
Chemical agents, chemotherapeutic
agents, viruses, radiation and
immunologic deficiency are associated
with development of leukemia
Radiations near nuclear reactor causes
13. Acute lymphocyte leukemia is malignant disorder arising
from a single lymphoid stem cell, with impaired maturation
and accumulation of the malignant cells in the bone marrow.
Diagnosis is confirmed by bone marrow aspiration or
biopsy, which typically shows different stages of lymphoid
Very immature cells forms.
The greater the number of immature cells, the poorer will be
15. CLINICAL MANIFESTATIONS:
• Anaemia from decreased RBCs
• Infection from neutropenia
• Bleeding from decreased platelet
• Weakening of the bone
• Spleen and liver enlargement
17. DIAGNOSTIC EVALUATION:
• History collection
• Physical examination
• Peripheral blood smear (immature forms
• Bone marrow aspiration or biopsy.
• Lumbar puncture is performed to
determine if there is any CNS
Treatment of leukemia involves the use of
chemotherapeutic agents, with or without
any of these four phases:
1. Induction therapy
2. CNS prophylactic therapy
3. Intensification therapy
4. Maintenance therapy
19. 1. INDUCTION THERAPY:
Induction aims at eradication of all
leukemia blast cells, which permits the
return of normal hematopoiesis. A number
of genetic or drug combinations are used.
The most common dug is prenizolone and
20. 2. CNS PROPHYLACTIC THERAPY:
Treatment of the CNS consists of
prophylactic therapy using intrathecal
chemotherapy with methotrexate, cytarbine
21. 3. INTENSIFICATION OR
After complete induction is obtained, a
period of intensified treatment is
administered to eradicate residual leukemic
cells, this is followed by delayed
intensification to prevent emergence of
resistant leukemia clones.
Chemotherapy including high dose or
intermediate dose methotrexate, cytarbine
is administered over a period of several
22. 4. MAINTENANCE THERAPY:
For maintenance therapy drugs like,
metropercate cyclophosphemide. Also
during maintenance therapy, periodic
Complete blood screening is done to
evaluate the bone marrow’s response to the
23. NURSING MANAGEMENT:
Give psychological support to the family
Encourage child to talk about feelings
Help family as they encourage child to
Give pain relief therapy
Avoid pressure on painful areas
Keep fresh air circulating in room
24. NURSING DIAGNOSIS:
1. Risk for infection related to neutropenia
from the disease process and treatment
• Follow the strict aseptic technique for
hand washing procedure.
• Monitor the vital signs frequents for
signs of infection.
• Administer antibiotics as ordered.
• To minimize exposure to infective
2. Risk for injury related to thrombocytopenia
• Monitor susceptibility to bleeding
• Assess for signs of bleeding including
petechial and bruising
• Monitor urine and stool for signs of occult
• Do the platelet count daily
• Decreased platelet count bruising, petechial and
blood in urine or stool can indicate bleeding
• Monitor for signs of haemorrhage (Decreased
BP, tachycardia, pallor, diaphoresis
• Avoid skin punctures when possible. Apply
pressure if punctures necessary for 5 – 10
• Children with platelet counts below 20000/mm3
are at risk for spontaneous bleeding
3. Pain related to diagnosis, disease process
• Assess the painful areas for location,
severity and signs of infection.
• Provide pain medication
• Provide psychological support
• Give play therapy
• Follow the doctors order
4. Imbalanced nutrition : less than body
requirement related to loss of appetite
nausea, vomiting and mucositis.
• Give small amount of food frequently
• Encourage high protein and high calorie
• Give food as per patient like and dislikes
• Administer antiemetics as ordered to