LEUKEMIA

Chronic Leukemia

CHRONIC LYMPHOCYTIC LEUKEMIA (CLL)

A

clonal malignancy of B-lymphocytes (rare Tlymphocytes) Most common variety of leukemia Idiopathic Genetic predisposition

Clinical Manifestations
Recurrent

infection Symmetrical enlargement of cervical, axillary or inguinal lymph nodes Splenomegaly Anemia and thrombocytopenia

Laboratory Findings
CBC:

increace WBC, in which 70-99% are lymphocytes; anemia Bone marrow is infiltrated with lymphocytes Decrease serum immunoglobulins

Staging for CLL

0 Absolute lymphocytosis >15x109 STAGE I Stage 0 + enlarged lymph nodes STAGE II Stage 0 + liver and/or spleen adenopathy STAGE III Stage 0 + anemia + organomegaly or adenopathy STAGE IV Stage 0 + thrombocytopenia + organomegaly or adenopathy
STAGE

CHRONIC MYELOGENOUS LEUKEMIA (CML)

Myeloploriferative

stem cell disorder resulting in proliferation of all hematopoeitic linkages, but manifest predominantly in the granulocytic series (neutrophils, eosinophils, basophils)

Pathogenesis
Philadelphia

(Ph) Chromosome Chromosome 9 and 22 BCR gene and ABL gene tyrosine kinase

Clinical Manifestations
Sx

related to hypermetabolism Splenomegaly Anemia Thrombocytopenia Hyperuricemia Visual disturbance and priapism

Laboratory Findings
FISH

Fluorescence in situ hybridisation CBC: increase WBC Anemia Hyperuricemia Decrease neutrophil alkaline phospate (NAP) score

Phase of CML
Chronic

Phase Acceleration Phase Blast Crisis

HAIRY CELL LEUKEMIA (HCL)

SURGICAL MANAGEMENT
Bone

Marrow Transplantation Stem Cell Transplantation Splenectomy

MEDICAL MANAGEMENT
CHEMOTHERAPY
Induction

Phase Consolidation or Intensification Phase Maintenance Phase Reinduction Phase

Chemotherapy for ALL

L-asparginase daunorubicin vincristine prednisone

Chemotherapy for AML

daunorubicin

or idarubicin

cytarabine

Chemotherapy for CLL

chlorambucil

CHOP

(cyclophosphamide, doxorubicin, vincristine, prednisone)

Chemotherapy for CML

imatinib

mesylate (Gleevec) first line hydroxyurea second line

NURSING DIAGNOSIS
Risk

for infection and bleeding Pain, acute or chronic Grieving

NURSING MANAGEMENT
Monitor/Assess Prevent

Infection Prevent Injury Conserve clients energy Managing Mucositis Easing Pain and Discomfort

 Maintaining

Fluid and Electrolyte Balance Improving Self-Care Encourage Spritual Well-Being Care after Discharge Client Education

Thank You!