Medical Nursing I – Leukemia Overview

Introduction to Leukaemia

• Abnormal overproduction of leukocytes occurs primarily in the bone marrow.
• Immature white blood cells (WBCs), known as blast cells, proliferate and suppress normal bone marrow function.
• Main characteristics include:
  • Replacement of normal bone marrow with malignant immature WBCs.
  • Presence of abnormal immature circulating WBCs.
  • Infiltration into organs such as the liver, spleen, and lymph nodes.

Causes and Risk Factors

• Etiology is often unknown; potential genetic damage leads to malignancy.
• Risk factors encompass:
  • Genetic predispositions (e.g., Down syndrome).
  • Viral infections (e.g., HTLV-1).
  • History of aggressive chemotherapy affecting the immune system.
  • Environmental exposures, including ionizing radiation, benzene, and certain medications.

Cell Types and Functions

• Key white blood cell types and their roles:
  • Neutrophils: Prevent bacterial infections via phagocytosis.
  • Monocytes: Differentiate into macrophages, important in fungal defense and immune surveillance.
  • Eosinophils: Engage in allergic reactions by neutralizing histamine and digesting foreign proteins.
  • Basophils: Contain histamine, crucial for hypersensitivity responses.
  • Lymphocytes: Vital part of the immune system, with subtypes:
    • T lymphocytes: Mediate cell-mediated immunity.
    • B lymphocytes: Generate antibodies; develop into plasma cells.
  • Plasma cells: Secrete immunoglobulins (antibodies).
• Erythrocytes (RBCs): Carry oxygen via hemoglobin; average lifespan is 120 days.
• Platelets (Thrombocytes): Essential for blood coagulation; average lifespan is 10 days.

Classification of Leukaemias

• Classifications are based on acuity and cell types:
  • Acute Leukaemias: Rapid onset with immature cells; untreated often fatal within weeks.
  • Chronic Leukaemias: Slower progression with mostly mature leukocytes; generally better prognosis.
  • Lymphocytic (Lymphoblastic): Affects immature lymphocytes.
  • Myelocytic (Myeloblastic): Involves myeloid stem cells, impacting development of blood cells.
  • Types include acute myeloblastic, chronic myelocytic, acute lymphoblastic, and chronic lymphocytic leukaemia.

Types of Leukaemia

Acute Myeloblastic Leukaemia (AML)

• Characterized by excess myeloblast proliferation and hyperplasia of bone marrow and spleen.
• Symptoms include fever, infections, bleeding, and weight loss.
• Diagnoses reveal immature blast cells and thrombocytopaenia.

Chronic Myelocytic Leukaemia (CML)

• Result of myeloid stem cell mutation, often linked to the Philadelphia chromosome translocation.
• Symptoms can be mild but include fatigue and splenomegaly.
• Exhibits three phases: chronic, transformation, and terminal blast crisis.

Acute Lymphoblastic Leukaemia (ALL)

• Rapidly proliferates precursor B or T lymphocytes; common in children.
• Symptoms include headaches, vomiting, and pain due to organ infiltration.

Chronic Lymphocytic Leukaemia (CLL)

• Accumulation of abnormal, mature lymphocytes, predominantly B lymphocytes.
• Manifestations include fatigue, infections, and abdominal pain.

Diagnostic Investigations

• Full blood count may show a normal leukocyte count with decreased normal cell percentages.
• Bone marrow aspiration/biopsy assesses disease characteristics and extent.
• Lumbar puncture may evaluate central nervous system involvement, particularly for ALL.

Treatment Approaches

• Primarily involves chemotherapy, with possible radiation and stem cell transplantation.
• Phases of chemotherapy include induction, intensification, CNS prophylactic, and maintenance.

Nursing Diagnoses and Management

• Priority nursing diagnoses may include risk for infection and impaired physical mobility due to isolation.
• Nursing management focuses on preventing and managing infections and bleeding, effective pain control, and maintaining nutrition and physical activity.

Complications Prevention

• Perform oral care with soft-bristled toothbrushes; no flossing allowed.
• Avoid medications that inhibit platelet function and use electric razors for shaving.
• Apply caution during venipuncture and control any bleeding with direct pressure.

Multiple Choice Questions Insights

• Recognizing risk for infection as the priority nursing diagnosis for newly diagnosed leukaemia patients.
• Understanding necessary diagnostic investigations for conditions like chronic myelocytic leukaemia, including blood culture and bone marrow aspiration.