Med-Surg: Chapter 34: Leukemia Flashcards
Leukemia
White blood cell disorder
- malignant disease or “blood cancer”
- disorder of the bone marrow in which WBCs begin multiplying uncontrollably
- acute or chronic
4 Major Leukemias
- acute myelogenous leukemia (AML)
- chronic myelogenous leukemia (CML)
- acute lymphoblastic leukemia (ALL)
- chronic lymphocytic leukemia (CLL)
Risk Factors
- downs syndrome
- presence of philadelphia chromosome (abnormal chromosome 22)
- exposure to radiation or benzene
- smoking
Pathophysiology
an unknown stimulus mutates either a myeloid or lymphoid stem cell
- this single cell clones itself, producing an immature WBC known as a leukemic cell, or blast, in which never matures as a result of the mutation
- this cloning process becomes uncontrollable, filling the bone marrow with these leukemic cells, which gets pushed into the circulation
- this uncontrollable production of WBCs is called leukocytosis
- b/c of the mutation, these WBCs never mature and do not respond to the normal signal that leads to programmed cell death, or apoptosis
- the bone marrow, spleen, and lymph tissue become congested with the blasts, leading to lymphadenopathies, splenomegaly, and infiltration of the body’s mucous membranes and lungs
Leukocytosis
uncontrollable production of WBCs
Clinical Manifestations
secondary to the blast congestion, lymph glands in the neck, axillae, or groin and the left upper abdominal quadrant may become swollen and painful
- risk of infection is increased b/c these leukemic WBCs do not mature; therefore, the number of mature infection-fighting cells, or neutrophils, decreases (neutropenia)
- low grade fevers in response to minor infections
- major infections (pneumonia) usually do not occur until after chemotherapy initiation, which can cause profound neutropenia where the absolute neutrophil count (ANC) is less than 1000 mm3
- as leukemia progresses, the bone marrow, which is congested with leukemic cells, is not able to adequately produce RBCs and Platelets; often present with clinical manifestations of anemia (fatigue, palloe, weakness, SOB, and bruising, petechiae, nosebleeds, and bleeding gums from the decreased number of platelets
Diagnosis
- presents to provider with complaints of flu-like symptoms (fatigue, low-grade fever, pallor)
- routine CBC reveals the leukemia; reveals leukocytosis (or increased WBC count); and demonstrates anemia and thrombocytopenia (low platelets) that occur as a result of congested bone marrow
- history and physical exam performed
- confirmation of the diagnosis usually follows a bone marrow biopsy that shows the type of leukemia and extent of the malignancy
- genetic testing can be performed to determine any chromosomal abnormalities
Systemic Chemotherapy
initiated to destroy the leukemic cells and induce a remission that indicates that the bone marrow is free of leukemic cells and is able to produce health blood cells
-remission does not = cure
Treatment Strategies: Two phases
- remission induction
- post-remission maintenance
Remission Induction
includes the initial administration of chemotherapeutic agents
-high doses of chemotherapy are given and may be accompanied by radiation therapy; usually causes the patient to become acutely ill; treatment may be worse than disease
Granulocyte colony stimulating factors (GCSFs)
given post-chemotherapy to stimulate the bone marrow to produce neutrophils
Filgrastim
- short acting
- subcutaneous injection
- given to prevent development of post-chemotherapeutic infections
Pegfilgrastim
- long-acting
- subcutaneous injection
- given to prevent development of post-chemotherapeutic infections
Post-remission maintenance
after the induction phase
- chemotherapy may continue at lower doses and/or less frequently in order to suppress the formation of leukemic cells
- may continue for months or years
Transplantation
-only possibility for a cure
-Bone marrow transplantation (BMT)
-Peripheral stem cell transplantation (PSCT)
-Hematopoietic stem cell transplantation (HSCT)
>donor cells are needed to transplant into the bloodstream (either autologous; patients own, or allogeneic; from a donor)