LEUKEMIA

I.DEFINITION
Cancers of the blood-forming tissues.
White blood cells may be produced in excessive amounts and are unable to work
properly which weakens the immune system.
In both men and women, leukemia incidence is highest among whites and lowest
among Chinese, Japanese, and Koreans. The incidence in men is about 50%
higher than in women for all racial/ethnic groups except Vietnamese, among
whom the male rates are only slightly higher.
TYPES OF LEUKEMIA:
1. Chronic lymphocytic leukemia (CLL)
CLL affects lymphoid cells and usually grows slowly.
It accounts for more than 15,000 new cases of leukemia each year.
Peopleoften diagnosed with the disease are over age 55.
2. Chronic myeloid leukemia (CML)
CML affects myeloid cells and usually grows slowly at first.
It accounts for nearly 6,000 new cases of leukemia each year.
It mainly affects adults.
3. Acute lymphocytic (lymphoblastic) leukemia (ALL)
ALL affects lymphoid cells and grows quickly.
It accounts for more than 6,000 new cases of leukemia each year.
ALL is the most common type of leukemia in young children but it also affects
adult.
4. Acute myeloid leukemia (AML)
AML affects myeloid cells and grows quickly.
It accounts for more than 18,000 new cases of leukemia each year.
It occurs in both adults and children.

II. RISK FACTORS
1. GENERAL
A. Gender: Men are more likely to develop CML, CLL and AML than women.
B. Age: The risk of most leukemias, with the exception of ALL, typically increases
with age.
2. GENETICS
A. Family history: First degree relatives of CLL patients, or having an identical twin
who has or had AML or ALL may increased risk for developing the disease.
B. Genetic diseases: Certain genetic abnormalities, such as Down syndrome, may
play a role in the development of leukemia.
3. LIFESTYLE
Smoking: Although smoking may not be a direct cause of leukemia, smoking
cigarettes does increase the risk of developing AML.
C. EXPOSURES
A.Exposure to high levels of radiation: Exposure to high-energy radiation (e.g., atomic
bomb explosions) and intense exposure to low-energy radiation from
electromagnetic fields (e.g., power lines).
B.Chemical exposure: Long-term exposure to certain pesticides or industrial chemicals
like benzene is considered to be a risk for leukemia.
D. PREVIOUS TREATMENT - Certain types of chemotherapy and radiation therapy for
other cancers are considered leukemia risk factors.
III. PATHOPHYSIOLOGY
Risk Factors
Myeloblast Transformatiobn

Blocks Differentiation Continuos accumulation

Immature cells
Increase amount of cells Hypermetabolism
Weight loss

Spleen liver bone cellular proliferation of other cells
Spleenomegaly hepatomegaly bone pain (crowd out)
fracture
decrease RBC decrease platelets

anemia Bleeding




IV. TREATMENT
A. Assessment
Fever or chills
Persistent fatigue, weakness
Frequent or severe infections
Losing weight without trying
Swollen lymph nodes, enlarged liver or spleen
Easy bleeding or bruising
Recurrent nosebleeds
Tiny red spots in your skin (petechiae)
Excessive sweating, especially at night
Bone pain or tenderness

B. Diagnosis
1. Physical exam
2. Blood tests: to check the number of white blood cells, red blood
cells, and platelets.
Leukemia causes a very high level of white blood cells and may
also cause low levels of platelets and hemoglobin, which is found
inside red blood cells.
3. Biopsy :A biopsy is the only sure way to know whether leukemia
cells are in your bone marrow
A. Bone marrow aspiration: Thick, hollow needle to remove samples
of bone marrow.
B. Bone marrow biopsy: Very thick, hollow needle to remove a
small piece of bone and bone marrow.

C. Management
1. Chemotherapy. Chemotherapy is the major form of treatment for
leukemia. This drug treatment uses chemicals to kill leukemia cells.
2. Biological therapy. Biological therapy works by helping your immune
system recognize and attack leukemia cells.
3. Targeted therapy. Targeted therapy uses drugs that attack specific
vulnerabilities within your cancer cells. (imatinib (Gleevec) stops the action of
a protein within the leukemia cells of people with chronic myelogenous
leukemia )
4. Radiation therapy. Radiation therapy uses X-rays or other high-energy
beams to damage leukemia cells and stop their growth.
5. Stem cell transplant. A stem cell transplant is a procedure to replace your
diseased bone marrow with healthy bone marrow.