1. LEUKEMIA

2. INTRODUCTION:
 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.
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3. DEFINITION:
Leukemia is a malignant disease of blood
forming organs of the body that results in
uncontrolled growth of immature white
blood cells.
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4. INCIDENCE:
 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
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5. ETIOLOGY:
 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
leukemia
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7. CLASSIFICATION:
1. Acute myelogenous leukemia (AML)
2. Acute lymphocytic leukemia (ALL)
3. Chronic myelogenous leukemia (CML)
4. Chronic lymphocytic leukemia (CLL)
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8. 1. AML
Age of onset: 60-70
years of age
Clinical
Manifestations:
• Fatigue and
weakness
• Headache
• Mouth sores
• Anemia
Diagnostics:
• Low RBC count,
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9. 2. ALL
Age of onset: Before
14 years
Clinical
manifestations:
• Fever,
• Pallor,
• Bleeding,
• Increased ICP
Diagnostics:
• high WBC
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10. 3. CML
Age of onset: 25-60
years
Clinical
manifestations:
• sternal tenderness,
• weight loss,
• joint pain,
• excessive
perspiration
Diagnostics:
• High platelet count
early and lower later
• Increased
polymorphoneuclear
neutrophils
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11. 4. CLL
Age of onset: 50-70
years
Clinical
manifestations:
• Anorexia,
• Splenomegaly,
• Night sweats,
• Weight loss.
Diagnostics:
• Mild anemia and
thrombocytopeni
a,
• Increased
lymphocytes.
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12. PATHOPHYSIOLOGY:
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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
development.
Very immature cells forms.
The greater the number of immature cells, the poorer will be
the prognosis.

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15. CLINICAL MANIFESTATIONS:
• Anaemia from decreased RBCs
• Infection from neutropenia
• Bleeding from decreased platelet
production
• Fever
• Weakening of the bone
• Fractures
• Spleen and liver enlargement
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17. DIAGNOSTIC EVALUATION:
• History collection
• Physical examination
• Peripheral blood smear (immature forms
of leukocytes)
• Bone marrow aspiration or biopsy.
• Lumbar puncture is performed to
determine if there is any CNS
involvement.
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18. MANAGEMENT
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
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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
vincristile.
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20. 2. CNS PROPHYLACTIC THERAPY:
Treatment of the CNS consists of
prophylactic therapy using intrathecal
chemotherapy with methotrexate, cytarbine
and hydrocortisone.
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21. 3. INTENSIFICATION OR
CONSOLIDATION THERAPY:
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
months.
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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
drugs.
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23. NURSING MANAGEMENT:
 Give psychological support to the family
members
 Encourage child to talk about feelings
 Help family as they encourage child to
express feelings
 Give pain relief therapy
 Avoid pressure on painful areas
 Keep fresh air circulating in room
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24. NURSING DIAGNOSIS:
1. Risk for infection related to neutropenia
from the disease process and treatment
Intervention
• 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
organism.
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25. CONTD..
2. Risk for injury related to thrombocytopenia
Intervention:
• Monitor susceptibility to bleeding
• Assess for signs of bleeding including
petechial and bruising
• Monitor urine and stool for signs of occult
bleeding
• Do the platelet count daily
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26. CONTD..
• Decreased platelet count bruising, petechial and
blood in urine or stool can indicate bleeding
• Monitor for signs of haemorrhage (Decreased
BP, tachycardia, pallor, diaphoresis
restlessness)
• Avoid skin punctures when possible. Apply
pressure if punctures necessary for 5 – 10
minutes
• Children with platelet counts below 20000/mm3
are at risk for spontaneous bleeding
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27. CONTD..
3. Pain related to diagnosis, disease process
and treatment.
Intervention:
• Assess the painful areas for location,
severity and signs of infection.
• Provide pain medication
• Provide psychological support
• Give play therapy
• Follow the doctors order
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28. CONTD..
4. Imbalanced nutrition : less than body
requirement related to loss of appetite
nausea, vomiting and mucositis.
Intervention:
• Give small amount of food frequently
• Encourage high protein and high calorie
diet
• Give food as per patient like and dislikes
• Administer antiemetics as ordered to
decrease nausea
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