Leukemia Flashcards
In pediatrics, leukemia’s cause is ___. __/__ of all childhood cancers. Refers to diseases of what?
- unknown
- 1/3
- refers to diseases of the bone marrow and lymphatics system,
Possible causes of leukemia in adults (2)
- Exposure to radiation or chemicals, certain genetic disorders, and viral infections are known to be risk factors for certain types of leukemia.
- Bone marrow damage from pelvic radiation or certain types of chemotherapy drugs can cause acute leukemia, typically occurring years after treatment for another malignancy
Classification of pediatric leukemias (4)
-Most pediatric leukemias in children are acute leukemias
- 75% are acute lymphoblastic leukemia (ALL) –> ALL type of cells involved—T cell, B cell, early pre-B cell, or pre-B cell
- 17% are acute myeloid leukemia (AML)
- 3% are juvenile myelomonocytic leukemia (JMML)
- Chronic leukemias are less common
Acute lymphoblastic leukemia facts (3)
- ALL is most common malignancy in children
- 85 % of cases between 2 – 10 years of age
- High survival rate; 70% for ALL
Acute myelogenous leukemia facts (3)
- AML is the second most common type of leukemia in children
- Its incidence peaks during the adolescent years
- The long-term survival rate for childhood AML is about 50%
Leukemia Risk factors (6)
- Male gender
- Age 2 to 5 years
- Caucasian race
- Down syndrome, Shwachman syndrome, or ataxia-telangiectasia
- X-ray exposure in utero
- Previous radiation-treated cancer
Prognosis of ALL (9)
- Initial WBC most significant (The higher the count the poorer the outcome, Greater than 100,000 WBC count = poor outcome, <50,000 better outcome)
- Type of cytogenetic factors and immunophenotype
- The age at diagnosis (Children 1 – 9 years old do better, Girls do better than boys)
- The extent of extramedullary involvement
Prognosis of AML (3)
- AML affects the myeloid cell progenitors or precursors in the bone marrow, resulting in malignant (invasive and fast-growing) cells.
- AML is less responsive to treatment than ALL. Toxicity from treatment is more common in AML and is likely to be more serious than with ALL.
- After remission is achieved, children require intensive chemotherapy to prolong the duration of remission.
ALL patho
• Abnormal lymphoblasts abound in the blood-forming tissues. The lymphoblasts are fragile and immature, lacking the infection-fighting capabilities of the normal WBC. The growth of lymphoblasts is excessive and the abnormal cells replace the normal cells in the bone marrow. The proliferating leukemic cells demonstrate massive metabolic needs, depriving normal body cells of needed nutrients and resulting in fatigue, weight loss or growth arrest, and muscle wasting. The bone marrow becomes unable to maintain normal levels of RBCs, WBCs, and platelets, so anemia, neutropenia, and thrombocytopenia result. As the bone marrow expands or the leukemic cells infiltrate the bone, joint and bone pain may occur. The leukemic cells may permeate the lymph nodes, causing diffuse lymphadenopathy, or the liver and spleen, resulting in hepatosplenomegaly. With spread to the CNS, vomiting, headache, seizures, coma, vision alterations, or cranial nerve palsies may occur
AML patho
• AML affects the myeloid cell progenitors or precursors in the bone marrow, resulting in malignant (invasive and fast-growing) cells. The French–American–British (FAB) classification system identifies eight subtypes of AML (M0 to M7), depending on myeloid lineage involved and the degree of cell differentiation. These subtypes are useful for determining treatment.
Leukemia Manifestations (14)
Pallor Fever Recurrent infection Lethargy, fatigue, listlessness Anorexia Weight loss Abdominal pain Nausea and vomiting Bone and joint pain Headache Enlarged lymph nodes Hepatomegaly/splenomegaly Unusual bleeding or bruising • Hemorrhage (petechiae or purpura)
Nursing dx for leukemia (16)
Fatigue Anxiety Ineffective family coping Risk for injury Risk for infection Pain Impaired mucous membranes Nausea Imbalanced nutrition: less than body Constipation Diarrhea Activity Intolerance Disturbed body image Risk for impaired skin integrity Grief Compromised family coping
Physical exam for pt with leukemia
- Take the child’s temperature (fever may be present), and look for petechiae, purpura, or unusual bruising (due to decreased platelet levels). Inspect the skin for signs of infection. Auscultate the lungs, noting adventitious breath sounds, which may indicate pneumonia (present at diagnosis or due to immunosuppression during treatment). Note location and size of enlarged lymph nodes. Palpate the liver and spleen for enlargement. Document tenderness on abdominal palpation.
- Take note of hx of chickenpox (Child with leukemia and chickenpox may have an overwhelming infection)
Lab dx for leukemia and significance (6)
- CBC –> Low hemoglobin and hematocrit, decreased RBC count, decreased platelet count, and elevated, normal, or decreased WBC count
- Peripheral blood smear –> Blasts
- Bone marrow analysis (Greater than 25% lymphoblasts, Immunophenotyping, Cytogenetic analysis)
Lumbar puncture (Determine CNS involvement (leukemic cell infiltration)
Liver function, BUN and creatinine (If abnormal, may preclude tx with certain chemo agents)
CXR (May reveal PNA or mediastinal mass)
Blood Smear
What will a blood smear show?
-Lymphoblasts
A common misconception is that although part of the definition of leukemia is an overproduction of WBCs, most often the leukocyte count is low.
