Leukemia and Acute Lymphocytic Leukemia (ALL)

Leukemia Overview

• Leukemia involves distorted and uncontrolled proliferation of white blood cells (leukocytes).
• It is the most frequently occurring type of cancer in children.

Acute Lymphocytic Leukemia (ALL)

• ALL is the most frequent type of leukemia, accounting for 75% of leukemia cases in children.
• It is also known as acute lymphoblastic leukemia, a cancer affecting blood and bone marrow.
• The malignant cell is a lymphoblast, which is an immature lymphocyte.
• ALL involves rapid proliferation of lymphocytes.
• Red blood cell and platelet counts fall, with increasing white blood cell elements invading body organs.
• Peak incidence occurs in children between 2 and 6 years old.
• Prognosis is less favorable in children younger than 1 year or older than 10 years at initial diagnosis, compared to those between 2 and 10 years old.

Lymphoblast and Lymphocyte

• A lymphoblast is an abnormal cell similar to a large lymphocyte, produced in large numbers in leukemia.
• Lymphocytes are white blood cells crucial for the body's immune system, fighting infections and diseases.
• Lymphocytes, also known as leukocytes, are part of the immune system.
• They are produced in the bone marrow.
• Lymphocytes are found in blood, lymph tissue, and lymphoid organs like lymph nodes, spleen, and thymus.

Types of Lymphocytes

• B lymphocytes (B cells) produce antibodies to help the body fight infections.
• T lymphocytes (T cells) help kill tumor cells and control immune responses.

Etiology

• The exact cause of leukemia is unknown.
• Predisposing factors include radiation, exposure to chemicals, and genetic influences.
• Children with Down syndrome have a higher risk.
• If one twin has leukemia, the other twin is more likely to develop it.

Assessment - Signs and Symptoms

• Bone marrow overproduces lymphocytes, impairing normal production of other blood components.
• Common signs include pallor, low-grade fever, and lethargy, indicative of anemia.
• Patients may display petechiae and bleeding from the oral mucous membrane.
• Bruising easily because of a low thrombocyte count.
• Enlargement of the liver and spleen may cause abdominal pain, vomiting, and anorexia.
• Invasion of abnormal lymphocytes into the bone periosteum leads to bone and joint pain.
• Central nervous system invasion can cause headaches and an unsteady gait.
• Physical assessment may reveal painless, generalized swelling of lymph nodes, especially submaxillary or cervical nodes.

Clinical Manifestations of ALL

• Pallor
• Fatigue
• Petechiae
• Bruising
• Bleeding
• Fever

Laboratory Findings

• Elevated leukocyte count is typical.
• In some cases, the leukocyte count might be normal or slightly decreased but mainly consists of immature cells.
• Low platelet and hematocrit counts are common.
• Red blood cell count is generally low.

Diagnostic Tests

• Bone Marrow Aspiration is performed to identify the type of WBC involved and document the type of leukemia.
• The presence of 25% or more blast cells confirms the diagnosis of leukemia.
• Blast cells, also known as immature or leukemia cells, are abnormal white blood cells.
• Radiographs of long bones may show lesions caused by the invasion of abnormal cells.
• Lumbar Puncture detects the presence of blast cells in the cerebrospinal fluid.

First Signs

• Nodules
• Pink rash
• Headache
• Sleepiness
• Fatigue
• Bruising
• Joint pain
• Coughing

Therapeutic Management

• Chemotherapy aims for complete remission or absence of leukemia cells.
• Common chemotherapy drugs include Vincristine, prednisone, dexamethasone, and Doxorubicin, administered over a period of 4 weeks.
• Allopurinol is given to manage high uric acid levels to prevent kidney damage.

Nursing Diagnosis and Interventions

• Risk for infection is related to the non-functioning white blood cells and immunosuppressive effects of therapy.
• Outcome Evaluation: Child's temperature remains lower, with no erythema or drainage on skin.
• A risk for deficient fluid volume exists due to the increased chance of hemorrhage related to poor platelet production.
• Absence of hemorrhage should be confirmed and look for epistaxis, hematuria, and hematemesis.
• Other signs of internal hemorrhaging can be melena and haematochezia.
• Pain is related to the invasion of leukocytes.
• Goal is for the child to state that pain is tolerable and if an infant pain can be assumed if they are not crying.
• Pulse rate and blood pressure should remain normal for age group.