ASUHAN KEPERAWATAN PADA PASIEN

DENGAN KEGANASAN SISTEM

HEMATOLOGI

Tita Puspita Ningrum

Fakultas Ilmu Keperawatan UBSI Bandung

“When you are willing to make sacrifices for a

great cause, you will never be alone.”
 LEUKEMIA

• Proliferasi tidak teratur atau akumulasi sel

darah putih dalam sumsum tulang,
menggantikan elemen sumsum tulang
• Juga Terjadi di hati, limpa, dan nodus limfatikus
 invasi organ non hematologis : meningen, GI
Tract, Ginjal, kulit
• Peningkatan sel darah Putih 500.000 -
1,000,000/mm3
Penyebab

• Idiopatik
• Pengaruh genetik
• Patogenesis virus
• Kerusakan sumsum tulang
akibat paparan radiasi atau
zat kimia (benzene)
KLASIFIKASI

BERDASARKAN GALUR SEL YANG TERKENA

• LEUKEMIA LIMFOSTITIK
• LEUKEMIA MIELOSITIK

BERDASARKAN MATURITAS SEL CANCER

• AKUT  SEL IMATUR
• KRONIK  SEL TERDEFISIENSI
 LEUKEMIA MIELOSITIK AKUT
• Mengenai Stem Sel hematopoetik yang kelak
berdiferensiasi ke semua sel mieloid ; monosit,
granulosit (basofil, netrofil, eosinofil), eritrosit,
trombosit
• Menyerang semua kelompok usia
• Insiden meningkat sesuai
dengan bertambahnya usia
• Leukemia nonlimfostitik
yang sering terjadi
MANIFESTASI KLINIK
• Mudah terkena infeksi  akibat granulositopenia
• Kelelahan
• Kelemahan
• Perdarahan  trombositopenia
• Proliferasi sel leukemi 
• Nyeri akibat pembesaran limpa dan hati
• Masalah kelenjar limfa
• Sakit kepala
• Muntah
• Nyeri tulang  penyebaran ke sumsum tulang
• Gejala terjadi 1 – 6 bulan
• Lab : ↓ eritrosit & trombosit
• Leukosit total normal / rendah / tinggi 
persentase sel normal ↓
• Pemeriksaan sumsum tulang  >> sel blast
imatur
 PENATALAKSANAAN

• Kemoterapi
• Obat yang biasa digunakan :
daunorubicin hydrocjloride (Cerubidine),
Cytarabine, Mercaptopurine
• Tranfusi darah
• Penangan infeksi
• Transplantasi sumsum tulang
PROGNOSIS
• Pasien yang mendapat penanganan  bertahan
1 tahun
• Kematian biasanya karena infeksi atau
perdarahan
• Usia < 40 tahun  angka ketahanan hidup : 2 – 5
bulan.
LEUKEMIA MIELOSITIK KRONIK
• Keganasan sel stem mieloid
• Lebih banyak terdapat sel normal
• Penyakit lebih ringan
• Abnormalitas genetik  kromosom Philadelphia 
Ditemukan pada 90 – 95 % pasien dengan CML
• Jarang menyerang individu usia < 20 tahun
• Insidensi meningkat seiring pertambahan usia
MANIFESTASI KLINIK
• MIRIP GAMBARAN AML TAPI LEBIH RINGAN
• PENINGKATAN LEUKOSIT >>>
• SPLENOMEGALI

PENATALAKSANAAN DAN PROGNOSIS

• Terapi : Busulfan (Myleran), hydroxyurea, Clorambucil
(Leukeran).
• Kortikosteroid
• Harapan hidup ↑ pada pasien < 50 tahun dengan transplantasi
sumsum tulang
• Biasanya berkembang jadi AML & resisten terhadap terapi
apapun
• Harapan hidup 3 – 4 tahun
 LEUKEMIA LIMFOSITIK AKUT (ALL)
• Dianggap sebagai suatu proliferasi ganas
limfoblas, paling sering terjadi pada anak-
anak,
• Laki-laki lebih banyak dibanding
perempuan, dan puncak insidensi pada
usia 4 tahun,
• Setelah usia 15 tahun
ALL jarang terjadi
MANIFESTASI KLINIK
• Limfosit imatur berproliferasi dalam sumsum tulang
dan jaringan perifer
• Limfosit imatur mengganggu perkembangan sel
normal
• Hematopoetik normal terhambat  ↓ leukosit,
• ↓ erotrosit, ↓ trombosit
• Inflitrasi leukemia ke organ lain 
 nyeri karena hepatomegali atau splenomegali
 Sakit kepala
 Mual muntah
 Nyeri tulang
PENATALAKSANAAN
• 60% ANAK MENCAPAI KETAHANAN HIDUP
SAMPAI 5 TAHUN
• TERAPI : KEMOTERAPI KOMBINASI
Vincristin, prednison, daunorubicin,
asparginase
• Radiasi untuk daerah kraniospinal
LEUKEMIA LIMFOSITIK KRONIK (LLK)
• Leukemia Limfositik Kronik (LLK) merupakan suatu
gangguan limfoproliferatif yang ditemukan pada
orang tua (umur median 60 tahun) dengan
perbandingan2:1 untuk laki-lak
MANIFESTASI KLINIK
• PROLIFERASI DAN AKUMULASI 30% LIMFOSIT
MATANG ABNORMAL KECIL DALAM SUMSUM
TULANG, DARAH PERIFER, DAN EKSTRAMEDULAR
DENGAN KADAR 100.000+/mm3 atau lebih.
• limfosit abnormal adalah limfosit B.
• ANEMIA
• INFEKSI
• PEMBESARAN NODUS LIMFA
• ERITROSIT DAN TROMBOSIT MUNGKIN
NORMAL/MENURUN
• Penurunan limfosit
KOMPLIKASI
• Perdarahan
• < granulosit matur (dibawah 100/ml darah) dan
normal, disfungsi imun  Infeksi sistemik
• Penghancuran sel selama kemoterapi  M↑ kadar
purin kristalisasi purin  Pembentukan batu ginjal
• Anemia
• Infiltrasi leukosit abnormal ke abdomen, toksisitas
obat kemo  Masalah GI TACT : mual muntah,
anoreksia, diare, lesi mukosa mulut
• Trombositopeni  20.000 mm3 risiko perdarahan
 KEMUNGKINAN MASALAH
KEPERAWATAN
• Nyeri berhubungan dengan infiltrasi leukosit jaringan
sistemik
• Gangguan nutrisi : kurang dari kebutuhan tubuh b.d
perubahan proliferatif gastrointestinal dan efek toksik
kemoterapi
• Kelemahan dan intoleransi aktivitas b.d anemia
• Gangguan integritas kulit : alopesia b.d efek toksik
kemoterapi
• Gangguan citra tubuh berhubungan dengan alopesia
atau perubahan cepat pada penampilan
• Resiko terhadap cedera : perdarahan yang
berhubungan dengan penurunan jumlah trombosit
MULTIPLE MYELOMA
• neoplastic
• plasma cells infiltrate the bone marrow
and destroy bone
• occurs in about 4 in 100,000 people
• Men are affected twice as often as
women
• usually occurs after age 40, with the
average age 65 years.
Etiology and Pathophysiology
• Risk factors include a family tendency toward the
disease,
• ionizing radiation, and exposure to herbicides,
insecticides, and chemicals (particularly benzene).
• Genetic factors and viral infections
PATHOPHYSIOLOGY
• abnormal plasma cells multiply out of control in the
bone marrow.
• These abnormal cells produce excessive amounts
of abnormal immunoglobulin and cytokines. The
accumulation of the abnormal cells (tumors) in the
bone marrow disrupts normal RBC, leukocyte, and
platelet production.
• The disruption of normal cell production leads to
anemia, impaired immune response with
susceptibility to infection, and bleeding
tendencies.
• The tumors disrupt normal bone marrow function
and weaken the bone, predisposing the patient to
frequent fractures.
SIGN
• The onset of multiple myeloma is gradual, and
symptoms
• appear when the skeletal system is heavily
involved
• backache,
• bone pain that is worse with movement,
• pathologic fractures
• severe pain.
DIAGNOSIS
• By x-ray
• bone marrow biopsy, and blood
• urine tests  The appearance of light chains from
the abnormal immunoglobulins in the urine, or
Bence-Jones protein
• Because the bone destruction during multiple
myeloma releases calcium  hypercalcemia
occurs that may lead to kidney stone and renal
impairment.
• The CBC  anemia, leukopenia, and
thrombocytopenia.
• bone marrow  large numbers of immature
plasma cells.
TREATMENT
• Chemotherapy or palliative radiation is used to
combat the disease.
• Pain control is a primary concern.
• Hypercalcemia and osteoporosis often develop,
and patients must be monitored and treated for
these complications.
• prevent pathologic fractures.
• The most common chemotherapy regimen is
melphalan and prednisone. It is given orally for 4 to
7 days  repeated at 4- 6 week intervals
TREATMENT

• Bisphosphonates such as etidronate (Didronel),

pamidronate (Aredia), or zoledronic acid (Zometa)
inhibit bone breakdown and thereby decrease
skeletal pain and hypercalcemia.

• The drug is given IV once a month to reduce blood

calcium levels.

• There is no cure for multiple myeloma, but stem cell

transplantation can prolong life for some patients
NURSING MANAGEMENT
• Supportive care for the many complications of the
disease and treatment is provided.
• Encouraging adequate hydration with an intake of
3 to 5 L of fluid a day to minimize problems from
hypercalcemia.
• Pain assessment and management are crucial to
the quality of life for the patient.
• Acetaminophen and NSAIDs are used along with
narcotic analgesics.
• Care is taken in moving the patient due to the
potential for
• fractures.
LYMPHOMA
• cancers of the lymphatic system.
• This system - composed of lymph nodes in neck,
armpits, groin, chest, and abdomen - removes
excess fluids from the body and produces immune
cells.
• Abnormal lymphocytes, a type of white blood cell
that fights infection, become lymphoma cells,
which multiply and collect in the lymph nodes.
• Over time, these cancerous cells impair The
immune system.
CLASSIFICATION

• Lymphomas are divided into two categories:

Hodgkin lymphoma and non-Hodgkin
lymphoma.

• About 12 percent of people with lymphoma

have Hodgkin lymphoma. Because
of breakthroug research, this once fatal
diagnosis has been transformed into a curable
condition.
• Most non-Hodgkin lymphomas are B-cell
lymphomas, and either grow quickly (high-grade)
or slowly (low-grade).
• There are 14 types of B-cell non-Hodgkin
lymphomas. The rest are T-cell lymphomas, named
after a different cancerous white blood cell, or
lymphocyte.
• The exact causes of lymphoma remain unknown;
however, the following factors increase your risk of
developing the disease:
• Older age
• Male
• Caucasian
• Having an autoimmune disease
• HIV/AIDS
• Diet high in meats and fat
• Being exposed to certain pesticides
• Symptoms of lymphoma include the following:
• Swollen lymph nodes in the neck, armpits, or groin
• Fever
• Weakness and fatigue
• Weight loss
• Sweating
• Difficulty breathing or chest pain
• Itchy skin
• Rash
DIAGNOSIS
• lymph node biopsy
• blood tests,
• bone marrow biopsies,
• imaging tests, such as a CT scan or PET
scan.
• The spleen and lungs.
• Hodgkin lymphoma is one of the most
curable types of cancer.