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Adult Medical-Surgical Nursing
HAEMATOLOGY MODULE:
LEUKAEMIA 2
Leukaemia: Description
 A group of malignant disorders affecting:
 White blood cells (lymphocytes or leucocytes)
 Bone marrow
 Lymph system
 Spleen
 (Introduction in Lecture 1)
Leukaemia: Classification
 Acute Myelogenous Leukaemia (AML) (Lecture 1)
 Acute Lymphocytic Leukaemia (ALL)
 Chronic Myelogenous Leukaemia (CML)
 Chronic Lymphocytic Leukaemia (CLL)
 Acute Lymphocytic Leukaemia
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
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)
ALL: Clinical Manifestations
 Sudden onset
 High susceptibility to infection:
 Prone to opportunistic infection (as Candida
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Albicans)
Fatigue
Pallor
Bleeding tendency
Bone pain: damaged overcrowded marrow
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
ALL: Management
 Intensive chemotherapy including intrathecal
 Destroys rapidly dividing blast cells
 (Chemotherapy included in Leukaemia Lecture 1)
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
 Chronic Myelogenous Leukaemia
CML: Description
 A chronic malignancy of granulocytes (mature cells,
not blast cells)
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
CML: Clinical Manifestations
 Gradual onset
 Chronic fatigue and weakness
 Pallor
 Weight loss
 Compromised immune response
 Splenomegaly
 Anaemia
 Bleeding tendency
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
CML: Management
 Less intensive treatment:
 (Resistant to intensive chemotherapy which is aimed
at dividing cells)
 Steroids
 Oral chemotherapy
 Blood transfusions
 (Maybe splenectomy)
CML: Prognosis
 Poor prognosis: (more serious than CLL)
 Death from infection or haemorrhage
 Often becomes acute as AML
 Chronic Lymphocytic Leukaemia
CLL: Description
 A gradual accumulation of small dysfunctional
lymphocytes in:
 Blood circulation
 Bone marrow
 Lymph nodes
 Spleen
CLL: Pathophysiology
 Non-functioning leukaemic B-cells accumulate
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slowly in bone marrow, spleen, liver, lymph nodes
Lymphocytosis in circulation
Immunoglobulins non-functioning
Impaired immune response
Anaemia
Thrombocytopaenia
CLL: “Hairy Cell” Leukaemia
 “Hairy Cell” Leukaemia: hairy appearance of
lymphocytes
 These are intensively destroyed by the spleen
 → splenomegaly
 Pancytopaenia → acute infection risk
CLL: Clinical Manifestations
 Gradual onset
 Chronic fatigue and weakness
 Pallor
 Weight loss
 Compromised immune response
 Splenomegaly, lymphadenopathy
 Anaemia
 Bleeding tendency
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
CLL: Management
 Splenectomy (reduce haemolysis)
 Steroids
 Oral chemotherapy
 (Resistant to intensive chemotherapy which is aimed
at dividing cells)
 Supportive blood transfusions
CLL: Prognosis
 Eventually blast crisis → ALL
 Infection
 Haemorrhage
 Death: (survival approximately 7 years)