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Slide 1 - 8/12/2009 1 LeukemiaDR Ibraheem Bashayreh, RN, PhD
Slide 2 - 8/12/2009 2 Leukemia A group of malignant disorders affecting the blood and blood-forming tissues of Bone marrow Lymph system Spleen Occurs in all age groups
Slide 3 - 8/12/2009 3 Leukemia Results in an accumulation of dysfunctional cells because of a loss of regulation in cell division Fatal if untreated Progressive
Slide 4 - 8/12/2009 4 Leukemia Often thought of as a childhood disease The number of adults affected with leukemia is 10 times that of children
Slide 5 - 8/12/2009 5 Leukemia Etiology and Pathophysiology No single causative agent Most from a combination of factors Genetic and environmental influences
Slide 6 - 8/12/2009 6 Leukemia Etiology and Pathophysiology Associated with the development of leukemia Chemical agents Chemotherapeutic agents Viruses Radiation Immunologic deficiencies
Slide 7 - 8/12/2009 7 Leukemia Classification Acute versus chronic Cell maturity Acute: clonal proliferation of immature hematopoietic cells (the formation of blood or blood cells ) Chronic: mature forms of WBC; onset is more gradual Nature of disease onset
Slide 8 - 8/12/2009 8 Leukemia Classification Type of white blood cell (WBC) Acute lymphocytic leukemia (ALL) Acute myelogenous leukemia (AML) Also called acute nonlymphoblastic leukemia (ANLL) Chronic myelogenous leukemia (CML) Chronic lymphocytic leukemia (CLL)
Slide 9 - 8/12/2009 9 Myelogenous Leukemia Leukemia characterized by proliferation of myeloid tissue (as of the bone marrow and spleen) and an abnormal increase in the number of granulocytes, myelocytes, and myeloblasts in the circulating blood
Slide 10 - Myeloid tissue is a biologic tissue with the ability to perform hematopoiesis. It is mainly found as the red bone marrow in bones, and is often synonymous with this. However, myeloid can also be present in the liver and spleen . A myelocyte is a young cell of the granulocytic series, occurring normally in bone marrow, but not in circulating blood (except when caused by certain diseases). 8/12/2009 10
Slide 11 - Granulocytes are a category of white blood cells characterized by the presence of granules in their cytoplasm.[1] They are also called polymorphonuclear leukocytes (PMN or PML) because of the varying shapes of the nucleus, which is usually lobed into three segments. The myeloblast is a unipotent stem cell, which will differentiate into one of the actors of the granular series. 8/12/2009 11
Slide 12 - 8/12/2009 12 Acute Myelogenous Leukemia (AML) Leukemia characterized by proliferation of myeloid tissue (as of the bone marrow and spleen) and an abnormal increase in the number of granulocytes, myelocytes, and myeloblasts in the circulating blood One fourth of all leukemias 85% of the acute leukemias in adults Abrupt, dramatic onset Serious infections, abnormal bleeding Uncontrolled proliferation of myeloblasts Hyperplasia of bone marrow and spleen
Slide 13 - 8/12/2009 13 Acute Lymphocytic Leukemia (ALL) Most common type of leukemia in children 15% of acute leukemia in adults Immature lymphocytes proliferate in the bone marrow
Slide 14 - 8/12/2009 14 Acute Lymphocytic Leukemia Signs and symptoms may appear abruptly Fever, bleeding Insidious with progressive Weakness, fatigue Central nervous system manifestations
Slide 15 - 8/12/2009 15 Chronic Myelogenous Leukemia (CML) Excessive development of mature neoplastic granulocytes in the bone marrow Move into the peripheral blood in massive numbers Ultimately infiltrate the liver and spleen
Slide 16 - 8/12/2009 16 Chronic Myelogenous Leukemia Philadelphia chromosome The chromosome abnormality that causes chronic myeloid leukemia (CML) (9 &22) Genetic marker Chronic, stable phase followed by acute, aggressive (blastic) phase
Slide 17 - 8/12/2009 17 Chronic Lymphocytic Leukemia (CLL) Production and accumulation of functionally inactive but long-lived, mature-appearing lymphocytes B cell involvement Lymph node enlargement is noticeable throughout the body ↑ incidence of infection
Slide 18 - 8/12/2009 18 Chronic Lymphocytic Leukemia Complications from early-stage CLL is rare May develop as the disease advances Pain, paralysis from enlarged lymph nodes causing pressure
Slide 19 - 8/12/2009 19 Hairy Cell Leukemia 2% of all adult leukemias Usually in males > 40 years old Chronic disease of lymphoproliferation B lymphocytes that infiltrate the bone marrow and liver
Slide 20 - 8/12/2009 20 Hairy Cell Leukemia Cells have a “hairy” appearance Symptoms from Splenomegaly, pancytopenia, infection, vasculitis Treatment alpha-interferon, pentostatin, cladribine
Slide 21 - 8/12/2009 21 Unclassified Leukemias Subtype cannot be identified Malignant leukemic cells may have Lymphoid, myeloid, or mixed characteristics Frequently these patients do not respond well to treatment Poor prognosis
Slide 22 - 8/12/2009 22 Leukemia Clinical Manifestations Relate to problems caused by Bone marrow failure Overcrowding by abnormal cells Inadequate production of normal marrow elements Anemia, thrombocytopenia, ↓ number and function of WBCs
Slide 23 - 8/12/2009 23 Leukemia Clinical Manifestations Relate to problems caused by Leukemic cells infiltrate patient’s organs Splenomegaly Hepatomegaly Lymphadenopathy Bone pain, meningeal irritation, oral lesions (chloromas)
Slide 24 - 8/12/2009 24 Leukemia Diagnostic Studies To diagnose and classify Peripheral blood evaluation (CBC and blood smear) Bone marrow evaluation To identify cell subtype and stage Morphologic, histochemical, immunologic, and cytogenic methods
Slide 25 - 8/12/2009 25 Leukemia Collaborative Care Goal is to attain remission (when there is no longer evidence of cancer cells in the body) Chemotherapeutic treatment Induction therapy Attempt to induce or bring remission Seeks to destroy leukemic cells in the tissues, peripheral blood, bone marrow Patient may become critically ill Provide psychological support as well
Slide 26 - 8/12/2009 26 What is remission? The main aim of treatment for acute lymphoblastic leukaemia is to give a remission. This means that the abnormal, immature white cells or blasts can no longer be detected in your blood or bone marrow, and normal bone marrow has developed again. However, once you are in remission there may still be a very small number of abnormal lymphoblasts left. To destroy these, your doctor may prescribe maintenance or continuation chemotherapy which may last for several years. These drugs are mainly taken as tablets and you will need to have regular check-ups to monitor their effect. Very specialised blood tests to find particular proteins present on the surface of the leukaemia cells can show if any leukaemia cells are still present in the body. For many people with acute lymphoblastic leukaemia the remission lasts indefinitely and the person is said to be cured.
Slide 27 - 8/12/2009 27 Leukemia Collaborative Care Chemotherapeutic treatment (cont.) Intensification therapy High-dose therapy May be given after induction therapy Same drugs at higher doses and/or other drugs
Slide 28 - 8/12/2009 28 Leukemia Collaborative Care Chemotherapeutic treatment (cont.) Consolidation therapy Started after remission is achieved Purpose is to eliminate remaining leukemic cells that may not be evident Maintenance therapy Lower doses of the same drug
Slide 29 - 8/12/2009 29 Leukemia Chemotherapy Regimens Combination chemotherapy Mainstay treatment 3 purposes ↓ drug resistance ↓ drug toxicity to the patient by using multiple drugs with varying toxicities Interrupt cell growth at multiple points in the cell cycle
Slide 30 - 8/12/2009 30 Leukemia - Bone Marrow and Stem Cell Transplantation Goal Totally eliminate leukemic cells from the body using combinations of chemotherapy with or without total body irradiation
Slide 31 - 8/12/2009 31 Leukemia - Bone Marrow and Stem Cell Transplantation Eradicates patient’s hematopoietic stem cells Replaced with those of an HLA-matched (Human Leukocyte Antigen) Sibling (is a brother or a sister; that is, any person who shares at least one of the same parents ) Volunteer Identical twin Patient’s own stem cells removed before
Slide 32 - 8/12/2009 32 Nursing Management Planning Overall goals Understand and cooperate with the treatment plan Experience minimal side effects and complications of disease and treatment Feel hopeful and supported during the periods of treatment, relapse, and remission
Slide 33 - 8/12/2009 33 Nursing Management Many physical and psychological needs Evokes great fear Family also needs help Balance demanding technical needs with a humanistic, caring approach
Slide 34 - 8/12/2009 34 Patient empowered by knowledge of the disease and treatment can have a more positive outlook and improved quality of life Nurses face special challenges when meeting the intense psychosocial needs of a patient with leukemia Nursing Management
Slide 35 - 8/12/2009 35 Nursing Management Ongoing care is necessary to monitor for signs and symptoms of disease control or relapse Teach patient and significant other Diligence in disease management Need for follow-up care When to seek medical attention
Slide 36 - 8/12/2009 36 Nursing Management Goals of rehabilitation Manage Physical Psychosocial Social Spiritual Delayed effects Support groups
Slide 37 - 8/12/2009 37 Nursing Management Evaluation Cope effectively with diagnosis, treatment regimen, and prognosis Attain and maintain adequate nutrition Experience no complications Feel comfortable and supported
Slide 38 - 8/12/2009 38 BEST WISHES