what is leukemia?
group of malignant disease that affect:
- blood
- blood forming tissue of the bone marrow
- lymph system
- spleen
its the accumulation of dysfunctional cells d/t loss of regulation in cell division
long term survival rate
what is the etiology of leukemia?
- genetic and environemental factors
what is leukostasis?
A high leukemia WBC count in the peripheral blood can cause the blood to thicken and potentially block circulatory pathways
what are the 4 major types of leukemia?
1) acute lymphocytic leukemia (ALL)
2) acute myelogenous leukemia (AML)
3) chronic myelogenous (granulocytic) leukemia (CML)
4) chronic lymphocytic leukemia (CLL)
what are clinical manifestations of leukemia?
- wt loss/ anorexia
- chills, night sweat
- fatigue w progressive weakness
- bone and joint pain
- muscle cramps
- dyspnea, cough
- N and V
- dysphagia, mouth sores
- hematuria
- decreased UO
- diarrhea
- dark or bloody stools
- headaches, confusion, visual disturbance
- easy bruising
- epistaxis (nose bleed)
- fever
- tachycardia (dt anmeia)
- msk wasting (inactivity, bone/joint pain, decrased oxygenation)
- gingival bleeding
what are the diagnostic studies for leukemia?
- hx
- physical exam (bruising, bleeding, swelling of lymph nodes)
- blood test (CBC, WBC count)
- blood chemistries (electrolytes, uric acid, BUN, coag, LFTs)
- blood type , HLA typing (match patients and donors for bone marrow or cord blood transplants)
- lumbar puncture - to determine cns involvement
- bone marrow aspirate
- CXR, CT - to check if spread
what is the correlation between uric acid blood test and chemotherapy?
Rapid cell turnover from such treatment can increase uric acid levels
what is/is in a CBC?
- RBC (erythrovytes, reflect bone marrow fx), contain Hgb (provides oxygen transport
- throbocytes (platelets)- prev bleeding
- HCT = % of RBC to whole blood
- reticulocyte count
- WBC count
- leukocytes = high during inflammation or
immune response - Differentiated WBC (determines percentage of each type of WBC and of they are normal or immature)
- Absolute neutrophil count (measures actual nmbr of neutrophils)
- stained peripheral blood smear
how is bone marrow aspirate done?
- use the posterior iliac crest (back of hip or knee)
- sterile procedure
- painful
- needle local anaesthetic (EMLA or xylocaine)
- in younger children -> conscious sedation
- pressure drsg to site after
what is remission?
Presence of less than 5% blasts in the patients bone marrow
Peripheral blood counts must return to normal.
Adenopathy or organomegaly must be absent
what is the use of combination therapy?
1) decrease drug resistance
2) minimize drug toxicity
3) interrupt cell growth at mutiple points in cell cycle
- corticosteroids given to supress immune system
what are the stages of chemotherapy treatment?
1) induction therapy
2) intensification therapy
3) consolidation therapy
4) maintenance therapy
what is induction therapy?
the goal is to kill all leukemic cells in the bone marrow – inducing myelosuppression
chemo for 4-6 wks
cocktail of diff chemo agents and prednisone
given intrathecally to ensure no cns involvement - wbc can cross bbb
what is myelosupression?
condition in which bone marrow activity is decreased, resulting in fewer red blood cells, white blood cells, and platelets.
what is tumor lysis syndrome?
when large number of cancer cells die within a short period, releasing their contents in to the blood dt chemo
can lead to ARF and cardiac dysfnx
associated w tumors that have high growth rate, and are sensitive to the effects of chemo
can occur with the first 24-48h after initiation of chemo and last 5-7days
oncologic emergency
increased K, P, Uric acid, BUN, LDH
low Ca
how do you prevent tumor lysis syndrome?
- identify at risk pt
- aggressive hydration (without potassium), to increase UO
- aggressive diuresis
- lab q6hrs
- strict I and o
- weights
- allopurinol: used to lower levels of uric acid in your blood
what is intensification therapy?
high dose therapy given immediately after induction therapy for several months
may use same drug but at higher dose to maximize killing of cells and to minimize chances of recurrence of disease
what is the goal of consolidation phase?
it is started after remission is achieved
consist of one or two additional courses of the same drugs given during induction or involve high-dose therapy
purpose of consolidation therapy is to eliminate remaining leukemic cells that may not be clinically or pathologically evident
what is maintenance therapy?
treatment with lower doses of the same drugs used in induction or other drugs
given every 3 to 4 weeks for a prolonged period of time (last 2 years-outpatient)
goal is to keep the body free of leukemic cells/maintain remission
involves oral agents as well + occasional intrathecal inj
what is relapse?
when the cancer comes back
If a relapse occurs, could try systemic treatment again – often not as successful
ordered by hematology:
Biologic agents may be used at this point as well (e.g. Interferon - tells body theres an infection going on)
what is hematopoietic stem cell transplant (HSCT)? what are complications?
HSCT replaces the diseased or malfunctioning bone marrow with viable blood stem cells.
1) ALLOGENIC
2) SYNERGENEIC
3)AUTOLOGOUS
complications:
- GVHD (give fast acting corticosteroid)
- relapse
- infection
what are some nursing management/consideration related to safety? (risk of infection)
- low dose septra for prevention
- private room (positive pressure, Hepa filter)
- restrict visitors
- hand washing
- PPE
- wash fruits veggies
- no fresh flowers/plants
- limit punctures
- no rectal temp
- mouth and perineal care
- no tampons
- aseptic technique
- can return to school when wbc normal ish
- anergy testing: revaccinated 3-6 mo after chemo
what are some nursing management/consideration related to safety related to chemo?
- gloves when handling chemo agent + excreta (urine+stool)
what are some nursing management/consideration related to bleeding?
- soft sponge toothbrush
- no flossing but oral rinse is ok
- reduce needle sticks
- teach how to manage nose bleeds
- administer platelets or platelet rich plasma
- administer PRBCs
