Adult Medical-Surgical Nursing H A E M A T O L O G Y M O D U L E : L E U K A E M I A 2

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1 Adult Medical-Surgical Nursing H A E M A T O L O G Y M O D U L E : L E U K A E M I A 2

2 Leukaemia: Description A group of malignant disorders affecting: White blood cells (lymphocytes or leucocytes) Bone marrow Lymph system Spleen (Introduction in Lecture 1)

3 Leukaemia: Classification Acute Myelogenous Leukaemia (AML) (Lecture 1) Acute Lymphocytic Leukaemia (ALL) Chronic Myelogenous Leukaemia (CML) Chronic Lymphocytic Leukaemia (CLL)

4 Acute Lymphocytic Leukaemia

5 Acute Lymphocytic Leukaemia (ALL) Only 15% of adult leukaemia Most common leukaemia of childhood Acute onset Good remission and cure rate in children but not adults

6 ALL: Pathophysiology Lymphoblasts (immature dysfunctional lymphocytes) proliferate in the blood and bone marrow Lymphoblasts frequently pass to the central nervous system (CNS) across the blood-brain barrier Treatment involves intra-thecal chemotherapy (into the cerebrospinal fluid via lumbar puncture)

7 ALL: Clinical Manifestations Sudden onset High susceptibility to infection: Prone to opportunistic infection (as Candida Albicans) Fatigue Pallor Bleeding tendency Bone pain: damaged overcrowded marrow

8 ALL: Diagnosis CBC Blood film: Extremely increased number of immature white cells (lymphoblasts) RBC and platelets Bone marrow biopsy: crowding of lymphoblasts Lumbar puncture and CT scan for evidence of leukaemia outside blood or bone marrow

9 ALL: Management Intensive chemotherapy including intrathecal Destroys rapidly dividing blast cells (Chemotherapy included in Leukaemia Lecture 1)

10 ALL: Prognosis ALL is more prevalent in childhood Poor prognosis for adults (<25% achieve 5-year continuous remission) Good cure rate (50-75%) in children

11 Chronic Myelogenous Leukaemia

12 CML: Description A chronic malignancy of granulocytes (mature cells, not blast cells)

13 CML: Pathophysiology Related to radiation A stem cell disorder where there is a translocation of genetic material from C22 the Philadelphia chromosome C9 Dysfunctional granulocytes of all stages are increased in blood and bone marrow Marked splenomegaly: extramedullary (site other than bone marrow) haematopoiesis/ infiltration

14 CML: Clinical Manifestations Gradual onset Chronic fatigue and weakness Pallor Weight loss Compromised immune response Splenomegaly Anaemia Bleeding tendency

15 CML: Diagnosis Patient history and clinical picture CBC Chromosome studies Bone marrow biopsy Granulocytes of all stages in peripheral blood and bone marrow WCC >100, 000/ cmm3 (ref. 5-10,000) Reduced thrombocyte and red cell count

16 CML: Management Less intensive treatment: (Resistant to intensive chemotherapy which is aimed at dividing cells) Steroids Oral chemotherapy Blood transfusions (Maybe splenectomy)

17 CML: Prognosis Poor prognosis: (more serious than CLL) Death from infection or haemorrhage Often becomes acute as AML

18 Chronic Lymphocytic Leukaemia

19 CLL: Description A gradual accumulation of small dysfunctional lymphocytes in: Blood circulation Bone marrow Lymph nodes Spleen

20 CLL: Pathophysiology Non-functioning leukaemic B-cells accumulate slowly in bone marrow, spleen, liver, lymph nodes Lymphocytosis in circulation Immunoglobulins non-functioning Impaired immune response Anaemia Thrombocytopaenia

21 CLL: Hairy Cell Leukaemia Hairy Cell Leukaemia: hairy appearance of lymphocytes These are intensively destroyed by the spleen splenomegaly Pancytopaenia acute infection risk

22 CLL: Clinical Manifestations Gradual onset Chronic fatigue and weakness Pallor Weight loss Compromised immune response Splenomegaly, lymphadenopathy Anaemia Bleeding tendency

23 CLL: Diagnosis Patient history and clinical picture CBC, bone marrow biopsy Lymphocytosis: WCC >100, 000/ cmm3 (ref. 5-10,000) Dysfunctional lymphocytes of all stages in peripheral blood and marrow Presence of Hairy Cell lymphocytes

24 CLL: Management Splenectomy (reduce haemolysis) Steroids Oral chemotherapy (Resistant to intensive chemotherapy which is aimed at dividing cells) Supportive blood transfusions

25 CLL: Prognosis Eventually blast crisis ALL Infection Haemorrhage Death: (survival approximately 7 years)

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