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Flashcards in leukemia Deck (36):
1

leukemia

A malignant disorder of the hematopoietic system involving the bone marrow
Cause: Unknown

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leukemia risk factors

1. Immunodeficiency Disorders
2. Genetic Factors (evidence of familial clustering, Down’s Syndrome)
3. Exposure to ionizing radiation and chemicals
4. Viruses: infection with the human T-cell leukemia virus type 1
5.Exposure to Cytotoxic Chemicals (chemo)

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leukemia patho

Bone marrow’s control of cell proliferation and maturation is absent or abnormal;
Marrow is replaced by immature and undifferentiated leukocytes, or blast cells

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characteristics of normal leukocytes

1.

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characteristics of leukemic cells

1. >5% blasts in bone
2. Blasts often present in peripheral blood
3. Immature
4.Multiply continuously
5. Provide NO defense against infection

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leukemia patho

Proliferation of immature cells occurs and “crowds out” other marrow elements including erythrocytes and thrombocytes, resulting in inhibited growth and function of these cells; As a result “pancytopenia” occurs causing:
1. Anemia
2. Thrombocytopenia
3. Neutropenia

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myeloid

(involves cells of “bone marrow” origin) “myelogenous” or “non-lymphocytic” leukemia

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lymphocytic

(involves cells of “lymphatic” origin) “Lymphocytic” leukemia

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chronic leukemia

the predominant cell is “mature-appearing,” although it does NOT function normally; usually a “cytic” cell

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acute leukemia

the predominant cell is “immature,” usually a blast cell

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In general, acute leukemias tend to have a rapid onset and progression resulting in

100% mortality within days to months without appropriate treatment

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Chronic leukemias tend to have a

more indolent course

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leukemic clinical manifestations

1. Fatigue, malaise
2. Infections*
3. Bleeding (bruising, petechiae)
4. Fevers
5. Night Sweats
6. Weight loss
7. Anorexia

14

In addition, with Acute Lymphocytic Leukemia, CNS infiltration seen as:

Headache
Nausea
Vomiting

15

leukemia diagnostics

CBC: reflects anemia, thrombocytopenia, neutropenia
Differential: indicate main cell type involved
Bone marrow aspiration (or biopsy): typically show a proliferation of blast cells
Lumbar puncture is done to determine leukemic proliferation of CNS

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Acute Myelogenous (Non-Lymphocytic) Leukemia AML

-More common in: adolescents and adults over 55 years
-Prognosis better in children
-Associated with: Downs Syndrome
-Greatest risk of: “leukostasis” (stagnation of blood cells due to large number of cells) and “tumor lysis” syndrome
-Complication associated with rapid destruction of WBCs: leads to uric acid, potassium & calcium levels

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Tumor Lysis Syndrome

-Signs/sx include: dysrhythmias, confusion, paresthesias
-Hyperuricemia can occur leading to: acute renal failure and need for dialysis
-Treatment: allopurinol

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Acute Lymphocytic Leukemia ALL

-Most common type in children, but also prognosis best in children
-CNS infiltration is common

19

Chronic Myelogenous Leukemia CML

-Age at Onset: 18-30 years and 40-55 years
-May be familial; linked to chromosome abnormality called the: “Philadelphia chromosome” (90% of cases)
-Characterized by a chronic phase (2-7 yrs), followed by a “blast crisis” that resembles acute leukemia

20

Blast Crisis

-Occurs most commonly in individuals who have: AML, or convert to an AML type of leukemia from CML
-Peripheral Blast counts may range between 50,000-100,000 and result in:
1. Impaired blood flow to vital organs (leukostasis)
2. Leukostasis because large and “sticky” blasts plus arterioles and infiltrate local tissues

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Blast Crisis is a medical emergency if the following are present

1. Headache (from increased intracranial pressure)
2. Altered mental status
3. Dyspnea
4. Priapism: abnormal, prolonged and sustained erection of penis without sexual stimulation

22

Blast Crisis management

1. Hydrea in large doses destroy myeloblasts
2. Corticosteroids destroy lymphoblasts
3. Leukopheresis to remove abnormal WBCs from blood
4. Radiation therapy to treat brain or sever pulmonary compromise
5. Increased doses of chemo

23

Chronic Lymphocytic Leukemia CLL

-Usually occurs in: adults (>60 years)
-Responsive to oral chemotherapy
-Characterized by proliferation of: small, abnormal B lymphocytes, leading to decreased antibody response
-Cells accumulate in: spleen, lymph nodes
-More common in: men (3X)

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Leukemia management (chemo)

-Remission INDUCTION: initial tx of high doses of chemo to “empty” marrow of abnormal elements
-Post-remission therapy: leukemic cell population reduced to undetectable levels
-Consolidation therapy: intensive therapy given to further reduce remaining leukemic cells; may include BMT (bone marrow transplant)
-Maintenance therapy: long-term therapy in moderate dose to “maintain” a disease-free state

25

Leukemia Management (radiation)

-Prophylactic: cranial and testicular radiation in children (A.L.L.); these organs can be “sanctuary” sites for leukemic cells not eradicated by chemo
-Therapeutic: to destroy leukemic cells that have infiltrated tissues (spleen, lungs, brain)

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total body radiation

To destroy all leukemic cells in the bone marrow which may have resisted chemo. Can be used to prepare for BMT

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splenectomy

done when leukemic cells infiltrate spleen resulting in massive platelet destruction

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bone marrow transplant

-Potentially curative
-Transplant stems cells into a recipient who has received HIGH doses of chemo/radiation that have destroyed marrow

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diagnoses common with BMT

Leukemias
Lymphomas
Multiple Meylomas
Testicular Cancer
Myelodysplatic Syndromes
Some solid tumors

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sources of stem cells

bone marrow
peripheral blood
umbilical cord blood

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sources of stem cells BMT

Allogeneic: from a relative or unrelated donor having a closely matched HLA type
Syngeneic: from an identical twin
Autologous: from recipient

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BMT process

A total of 500-1000cc of marrow harvested from anterior iliac crest or sternum (using anesthesia)
Marrow is reinfused IV into recipient following “conditioning regime”

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Peripheral stem cell transplant

-Stem cells obtained from peripheral blood in outpatient procedure (separates stem cells from blood and return blood to donor)
-takes 2-4 hours
-Stem cells infused after “conditioning regime”

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successful transplant

Increase in RBCs and platelets in peripheral blood count
Usually occurs 2-4 weeks following marrow/peripheral blood stem cell infusion

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transplant complications

-Oral mucositis
-Infection
-Bleeding
-Failure to engraft
-Multiple organ dysfuntion due to chemo
-Graft vs. Host Disease (GVHD) (Donor cells react against host cells, Specific to Allogenic transplants, Affects skin, GI tract, liver (can be life threatening), Anti-rejection meds used)
-Veno-occlusive Disease (VOD) (Particulate matter blocks venules causing hepatomegaly with destruction of hepatocytes)

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leukemia nursing diagnoses

1. Risk for Infection
2. Risk for Injury: bleeding
3. Fatigue
4. Ineffective Coping r/t disease/treatment
5. Others: if infiltration of CNS, lungs occurs