Leukemia

is cancer of the blood cells. It starts in the bone marrow, the soft tissue inside most bones.
Bone marrow is where blood cells are made. When you are healthy, your bone marrow makes: White blood cells, which help your body fight infection. Red blood cells, which carry oxygen to all parts of your body. Platelets, which help your blood clot.

 When you have leukemia, the bone marrow starts to make a lot of abnormal white blood cells, called leukemia cells. They don't do the work of normal white blood cells, they grow faster than normal cells, and they don't stop growing when they should. Over time, leukemia cells can crowd out the normal blood cells. This can lead to serious problems such as anemia, bleeding, and infections. Leukemia cells can also spread to the lymph nodes or other organs and cause swelling or pain.

Four major kinds of leukemia

Cell Type
Lymphocytic Leukemia (or "lymphoblastic")

Acute
Acute lymphoblastic Leukemia (ALL)

Chronic
Chronic lymphocytic leukemia (CLL)

Myelogenous leukemia (also "myeloid" or "nonlymphocytic")

Acute myelogenous leukemia (AML) (or Myeloblastic)

Chronic myelogenous leukemia (CML)

ACUTE AND CHRONIC FORMS

Acute leukemia is characterized by a rapid increase in the numbers of immature blood cells. Crowding due to such cells makes the bone marrow unable to produce healthy blood cells. Immediate treatment is required in acute leukemia due to the rapid progression and accumulation of the malignant cells, which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of leukemia in children

 Chronic leukemia is characterized by the excessive build up of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can theoretically occur in any age group.

Lymphoblastic or lymphocytic leukemias and myeloid or myelogenousleukemias

In lymphoblastic or lymphocytic leukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes, which are infection-fighting immune system cells. Most lymphocytic leukemias involve a specific subtype of lymphocyte, the B cell. In myeloid or myelogenousleukemias, the cancerous change takes place in a type of marrow cell that normally goes on to form red blood cells, some other types of white cells, and platelets.

RARE TYPES
Acute lymphoblastic leukemia (ALL) is the most common type of leukemia in young children. This disease also affects adults, especially those age 65 and older. Standard treatments involve chemotherapy and radiotherapy. The survival rates vary by age: 85% in children and 50% in adults. Subtypes include precursor B acute lymphoblastic leukemia, precursor T acute lymphoblastic leukemia, Burkitt's leukemia, and acute biphenotypic leukemia.

Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 75%. It is incurable, but there are many effective treatments. One subtype is B-cell prolymphocytic leukemia, a more aggressive disease. Acute myelogenous leukemia (AML) occurs more commonly in adults than in children, and more commonly in men than women. AML is treated with chemotherapy. The five-year survival rate is 40%. Subtypes of AML include acute promyelocytic leukemia, acute myeloblastic leukemia, and acute megakaryoblastic leukemia.

Chronic myelogenous leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease. Treatment is with imatinib (Gleevec in US, Glivec in Europe) or other drugs. The five-year survival rate is 90 %.One subtype is chronic monocytic leukemia

 Hairy cell leukemia (HCL) is sometimes considered a subset of CLL, but does not fit neatly into this pattern. About 80% of affected people are adult men. There are no reported cases in children. HCL is incurable, but easily treatable. Survival is 96% to 100% at ten years.
T-cell prolymphocytic leukemia (T-PLL) is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease. Despite its overall rarity, it is also the most common type of mature T cell leukemia; nearly all other leukemias involve B cells. It is difficult to treat, and the median survival is measured in months. Large granular lymphocytic leukemia may involve either T-cells or NK cells; like hairy cell leukemia, which involves solely B cells, it is a rare and indolent (not aggressive) leukemia.

 Adult T-cell leukemia is caused by human T-lymphotropic virus (HTLV), a virus similar to HIV. Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the infected Tcells, giving them the ability to proliferate abnormally. Human T cell lymphotropic virus types I and II (HTLV-I/II) are endemic in certain areas of the world.

RISK FACTORS
Were exposed to large amounts of radiation. Were exposed to certain chemicals at work, such as benzene. Had some types of chemotherapy to treat another cancer. Have Down syndrome or some other genetic problems. Smoke.

Fever and night sweats. Headaches. Bruising or bleeding easily. Bone or joint pain. A swollen or painful belly from an enlarged spleen. Swollen lymph nodes in the armpit, neck, or groin. Getting a lot of infections. Feeling very tired or weak. Losing weight and not feeling hungry.

Ask questions about your past health and symptoms.

Do a physical exam. The doctor will look for swollen lymph nodes and check to see if your spleen or liver is enlarged.
Order blood tests. Leukemia causes a high level of white blood cells and low levels of other types of blood cells. If your blood tests are not normal, the doctor may want to do a BONE MARROW BIOPSY. This test lets the doctor look at cells from inside your bone. This can give key information about what type of leukemia it is so you can get the right treatment.

 Chemotherapy, which uses powerful medicines to kill cancer cells. This is the main treatment for most types of leukemia. Radiation treatments. Radiation therapy uses high-dose X-rays to destroy cancer cells and shrink swollen lymph nodes or an enlarged spleen. It may also be used before a stem cell transplant.
Stem cell transplant. Stem cells can rebuild your supply of normal blood cells and boost your immune system. Before the transplant, radiation or chemotherapy may be given to destroy cells in the bone marrow and make room for the new stem cells. Or it may be given to weaken your immune system so the new stem cells can get established. Biological therapy. This is the use of special medicines that improve your body's natural defenses against cancer.

Accepting Leukemia
Learn all you can about the type of leukemia you have and its treatment. This will help you make the best choices and know what to expect.

Stay as strong and well as possible. A healthy diet, plenty of rest, and regular exercise can help. Talk to other people or families who have faced this disease. Ask your doctor about support groups in your area. You can also go on the Internet and find stories of people who have leukemia.

PATHOPHYSIOLOGY

Name of the drug PURINETH OL (mercaptop urine) 50mg Scored Tablets

Adverse reaction PURINETHOL (mercaptopurine) is PURINETHOL competes with Hematolo indicated for maintenance should not be used gic: The hypoxanthine therapy of acute in patients whose and guaninefor most lymphatic(lymphocytic, disease has the enzymehypoxanthi lymphoblastic) leukemia as part of demonstrated frequent a ne-guanine a combinationre giment The prior resistance to dverse phosphoribosyltransfer response to this agent depends this drug. In reactionto animals and ase (HGPRTase) and upon the particular PURINET subclassification of acute humans, there is is itself converted to HOL is lymphatic leukemia and the age of usually complete thioinosinic acid myelosupp the patient (pediatric or adult). cross-resistance (TIMP). ression. between PURINETHOL is not effective This intracellular nucle The mercaptopurine for prophylaxis or treatment and thioguanine. otide inhibits several induction of central nervous reactions involving of system leukemia. PURINETHOL inosinic acid (IMP), should not be used complete r PURINETHOL is not effective including the emission in patients who in acute have a conversion of IMP to of acute ly myelogenousleukemia, chronic hypersensitivity to mphatic xanthylic acid (XMP) lymphatic leukemia, the mercaptopurine or leukemia f and the conversion of lymphomas (including Hodgkins any component of IMP to adenylic acid requently Disease), or solid tumors. the formulation. (AMP) via is DOSAGE: adenylosuccinate associated Dosage with concomitant (SAMP). with marro Allopurinol:When allopurinol and w hypopla mercaptopurine are administered sia. concomitantly, the dose of mercaptopurine must be reduced to one third to one quarter of the usual dose to avoid severe toxicity

Mechanism of action

Indication

Contraindications

Nursing consideration Patients should be informed that the major toxicities of PURINETHOL are related to myelosuppression, hepatotoxicity, and gastrointestinal toxicity. Patients should never be allowed to take the drug without medical supervision and should be advised to consult their physician if they experience fever, sore throat, jaundice, nausea, vomiting, signs of local infection, bleeding from any site, or symptoms suggestive of anemia. Women of childbearing potential should be advised to avoid becoming pregnant.

Name of the drug Elspar (asparaginase)

Mechanism of action The mechanism of action of Elspar is thought to be based on selective killing of leukemic cells due to depletion of plasma asparagin e. Some leukemic cells are unable to synthesize asparagine due to a lack of asparagine synthetase and are dependent on an exogenous sourc e of asparagine for survival. Depletion of asparagine, which results from treatment with the enzyme Lasparaginase, kills the leukemic cells. Normal cells, however, are less affected by the depletion due to their ability to synthesize asparagine.

indication Elspar is indicated as a component of a multi-agent chemotherapeutic re gimenfor the treatment of patients with acute lymphoblasti leukemia DOSAGE: Recommended Dose The recommended dose of Elspar is 6, 000 International Units/m intramuscularly (IM) or intravenously (IV) three times a week.

contraindications Serious allergic reactions to Elspar or other Escherichia coliderived Lasparaginases Serious thrombosi s with prior Lasparaginase ther apy Pancreatitis with prior Lasparaginase therapy Serious hemorrha gic events with prior Lasparaginase therapy

Adverse reaction Anaphylaxi s and serious allergic reactions Serious thr ombosis Pancreatitis Glucose int olerance Coagulopat hy

Nursing consideration For IM administration, reconstitute Elspar by adding 2 mL Sodium Chloride Injection to the 10,000 unit vial. Withdraw volume of reconstituted Elspar containing calculated dose into sterile syringe. For IV administration, reconstitute Elspar by adding 5 mL Sterile Water for Injection or Sodium Chloride Injection to the 10,000 unit vial.

Name of the Mechanism of action drug Vincasar PFS The mechanism of action of vincristine vincristine sulfate has been sulfate injection, USP related to the inhibition of microtubule formation in the mitotic spindle, resulting in an arrest of dividing cells at the metaphase stage .

indication VINCASAR PFS Injection is indicated in acute leukemia.VINCASAR PFS Injection has also been shown to be useful in combination with other oncolytic agents in Hodgkins disease,3 nonHodgkins malignant lymphomas 4-6 (lymphocytic, mixed-cell, histiocytic,DOSAGE:T he usual dose of VINCASAR PFS for children is 2 mg/m2. For children weighing 10 kg or less, the starting dose should be 0.05 mg/kg, administered once a week. The usual dose of VINCASAR PFS for adults is 1.4 mg/m2. A 50% reduction in the dose of VINCASAR PFS is recommended for patients having a direct serum bilirubin value above 3mg/dL.19

contraindications Patients with the demyelinating form of Charcot-MarieTooth syndrome should not be given VINCASAR PFS Injection. Careful attention sh ould be given to those conditions listed under WARNINGS and PRECAUTION S.

Adverse reaction In general, adverse reactions are reversible and are related to dosage. The most common adverse reaction is hair loss; the most troublesome adverse reactions are neuromuscular in origin.When single, weekly doses of the drug are employed, the adverse reactions of leukopenia, neuritic pain and constipation o ccur but are usually of short duration (i.e., less than 7 days).

Nursing consideration Caution - It is extremely important that the intravenous needle or catheter be properly positioned before any vincristine is injected. Leakage into surrounding tissue duri ng intravenous administration of VINCASAR PFS may cause considerable irritation. If extravasation occurs, the injection should be discontinued immediately, and any remaining portion of the dose should then be introduced into another vein. Local injection of hyaluronidase and the application of moderate heat to the area of leakage help disperse the drug and are thought to minimize discomfort and the

ASSESSMENT

DIAGNOSIS

INFERENCE

PLANNING

INTERVENTION

RATIONALE

SUBJECTIVE: Napansin ko na madalas ako mgkaroon ng pasa at palagi nalang akong pagod at nanghihina (Ive
noticed that I bruise easily and also I feel weak and tired all the time.) as

Risk for infection related to inadequate primary defenses.

verbalized by the patient. OBJECTIVE: Irritability Pallor of skin and mucous membrane s V/S taken as follows T: 37.1 P: 80 R: 19
BP: 100/80

Leukemias are cancers of the blood-forming tissues. White blood cells may be produced in excessive amounts and are unable to work properly which weakens the immune system.

After 8 hours of nursing interventions the patient will identify actions to prevent or reduce the risk for infection.

INDEPENDENT: Place the patient in private room. Limit visitors as indicated. Prohibit use of live plants or cut flowers. Restrict fresh fruits and vegetables or make sure they are washed or peeled. Require good handwashing protocol for all personnel and visitors. Encourage frequent turning and deep breathing. Handle patient gently. Keep linens dry or wrinkle free. Inspect skin for tender, erythematous areas, open wounds. Cleanse skin with antibacterial solutions. Inspect oral mucous membranes. Provide good oral hygiene. Use a soft toothbrush, sponge, or swabs for frequent mouth care. Promote good perineal hygiene. Examine perianal area at least daily during acute illness and provide sitz baths. Coordinate procedures and tests to allow for uninterrupted rest periods. COLLABORATIVE: Prepare for or assist patient with leukemia treatments such as chemotherapy, radiation, and bone marrow transplantation. Administer antibiotics as indicated.

After 8 hours of nursing interventions the patient was able to identify actions to prevent or reduce the risk for infection.
.

Submitted By:
AULMO, ELLESE GEM S.

CURA, MARY CON B.