:Objective

-defenses leukemia, identify the type of

leukemia.
-Identify S&s of leukemia.
- Identify high risk of leukemia ,Dx test
,therapeutic management ,and type of
Tx.
- Identify nursing intervention in the care
of the pt with leukemia.
 LEUKEMIA
leukemia is an .
abnormal,
uncontrolled
overproduction of
WBC by the stem cell
in bone marrow
,which affects the
rest of RBC ,platelets
.and body function

-
 Death comes from secondary comp
-lications resulting from the presence in
.vital tissues of these abnormal cells
Leukemia
 THE ETIOLOGY OF LEUKEMIA

The exact cause of leukemia is

.unknown
Although specific genes have been-
.identified that can cause leukemia
Children with Down syndrome have-
shown a higher incidence of
.leukemia
 -

Other risk factors include exposure to large-

doses of ionizing radiation or drugs that
.suppress bone marrow
 Certain viruses, such as human T-cell -
lymphotrophic virus type1,are also
associated with an increased risk for
.leukemia

Exposure to some chemical such as -

.gasoline
Pathophysiolgy
 Pathophysiolgy
The abnormal-1
WBC continues
to divide but not
mature beyond
.the blast state
it is released into the peripheral blood-
.as a blast ,an immature WBC

WBC RBC Platelet

 leukemic blast have no normal-
.functional capabilities

As the abnormal WBCs increase in-2

number, fewer and fewer normal cells
.are made

The proliferating blast cells don’t-

.attack and destroy normal cells
Rather ,they crowed out other healthy,-
functional cells, robbing them of
nutrition essential for metabolism
,leading to pancytopenia (reduction in
number of blood cells being produced
.by all cell lines

The bone marrow becomes packed-

with the malignant cells, and they spill
Out into the peripheral blood where
they can be seen on microscopic
.slides
-
 TYPE
????? 
??? 
?? 
?

Of leukemia
 Type of leukemia
There are several types of leukemia-
classified on the bases of the
morphology of the cells and the
. course of diseases
The disease-
can be acute
or chronic
 There are four major types of
:leukemia
Acute lymphoblast leukemia -1
(ALL): which represent 80% of
case , most commonly
occurs between the
age of (2 – 6 yrs) and
affect boys more
.than girls
 Acute myeloid leukemia -2
(AML) which is responsible for most of
.the remaining cases

chronic lymphocytic leukemia (CLL) -3

.Is rare in children
chronic myeloid leukemia (CML) is -4
represents less than 3% of leukemia
.in children
 -

Sign and symptom

 Clinical manifestation
Sign and symptom
-:of leukemia
Fever and show -
.sign of sepsis
Anemia causes -
weakness,
.malaise, pallor
 bruising, petechiae ,or bleeding from-
the nose and gums
.
 The spleen, liver, lymph nodes ,-
thymus and kidney
may become
.enlarged
bone pain( often accompanied by -
.limping)
weight loss-
fatigue -
irritability-
 Refusal to walk -
abdominal pain -
night sweats-
loss of appetite-
some time cancer cell may spread in-
the brain, causing headache
,convulsions and other neurological
.problem
.shortness of breathing-
 Pathophysiolgy leading to clinical manifestation of leukemia

Proliferation of immature WBC (blast)

Blast cells crowd out healthy WBCs ,RBCs ,platelet

Bone marrow depression

Enlargement of organs infiltrated by blast cells

WBC RBC platelets

Oxygen es

s
Clotting

y
Immune

ne
n

en

an
carrying

er
function capacity Bo

le

kid
liv

Gl
sp
capacity

Fever Weakness increased Bone pain Splenomegaly

infection Migratory Abdominal hepatomegaly Kidney
Malaise Bruising/petechiae -Enlarg
especially( pallor Nose bleeds joint fullness
Pulmonary Pain and ment
Bleeding from gums
urinary,, swelling
,)blood Lymphadenopathy
Local tenderness
Diagnostic test
 Diagnostic test
history (family history)-
.CBC (complete blood count)-
Lumber puncture ,CSF analysis-
reveals abnormal WBC invasion of
.CNS
.CXR, CT scan, MRI-
 Bone marrow
aspiration and biopsy.
. .-Chest radiograph
 Complication
Because leukemia and its treatment
affected all blood cell lines and the
immune system, complication vary
and can be severe. Infection are of
.particular concern
Children on long-term immunosuppre-
ssive therapy have over growth of
fungal infection, such as Candida
 or little resistance to severe fungal ,
.infection such as aspergillus's

Disruptions in the child's and the

family's routine problems with school
or socialization as well as stress and
.anxiety
Therapeutic management
 Therapeutic management
-The main objective of treatment to
eliminate all leukemia cells, type
of treatment depend on the type
of cancer and diagnosis cells.
**Requirement for treatment :
-The type of leukemia
 Age of pt.-
-The existence of leukemia in fluid
.meningitis
-Symptoms that appear on the pt and
public health.
***Method of treatment:
- Chemotherapy.
-Radiation therapy.
 -Bone marrow transplant.
-Surgery (spleenoctomy ).

*CHEMOTHERAPY*
-most pt with leukemia take
 chemotherapy this Tx is to kill cancer
.cells
It is administered by :-
1. By mouth) tablet , liquid ).
2. Injection (IV, IM ) .
3. Catheter.
4. Directly in liquid meningitis.
.
 S/E:-
 Fatigue and weakness.

Diarrhea, nausea , vomiting

 Infection occurs ,bleeding, mouth

ulcer

 Loss of hair
-:Radiation therapy
 •Are using high_ energy rays and have
the ability penetrate the tissue to kill
cancer cells.

 Aredirected by using the x-ray

specific to the brain, spleen and other
place that collection the cancer cells.
 -:Bone marrow transplant
 The first use of chemotherapy or
radiation therapy in order to be killed
and the destruction of cancer cell as
possible, as well as natural blood
cells then cultivated bone marrow
steam cells)
 The role of nature in the
-: treatment of leukemia
 One oddity of nature that camel milk,
urine is used in the treatment of
leukemia
 this urine is taken by three spoons
food with a glass of milk and then take
on an empty stomach.
•• It was found that the combination of
arsenic and vitamin A has a role in the
treatment of cancer of the blood and is 
used in the treatment of serious type of
leukemia, which is difficult to treat the
leukemia cells spinal chronic, which is
caused by stem cells, arsenic is paying
for this cell to the outside and can be
discarded once and for all through
treatment Chemotherapy or radiation.
 • The laughter has a big role with
good food in the treatment of
cancer of the blood and immune
booster has been found.

 Saffron:
one of the natural vegetation,
which prevent a new cancer tumors
and leads to contraction of existing
diseases.
 •• Olive oil: has been scientifically
proven that olive oil protects against
human cancer It prevents cancer cells
from dividing and spreading.
• honey bee
 Green tea
 grape seed
 . Usually doctors is an intensive
program of treatment that is in
several stages:-
 The induction phase (induction phase): and
include the provision of intensive treatment
to destroy the largest possible number of
cancer cells. They usually last this stage of
4-6 weeks. A test of the bone marrow at the
end of the stage to make sure there are no
cancer cells. If there are cells were not clear,
the status of the child is at the stage of
remission (remission).
 •Vincristine, prednisone, L- asparaginase.
 Antiplastic drugs.
 Increase IV fluids.
 Administration of allopurinol to protect the
kidneys from damage caused by tumor
cell breakdown,
 Antifungal agents such as nystatin .
 CNS Tx (methotrexate)
 Cytosine arabinoside, hydrocortisone.
Consolidation phase - This phase
involves keeping the state of remission
and maintenance of the absence of
cancer cells, and the prevention of the
spread of cells in the brain and spinal
cord. This phase can last for 4 -6 months,
and the treatment tablets daily and
monthly injections of chemotherapy

 maintenance phase :its provides to
maintain the remission its usually
Given for 2 -3 years.
Standard maintenance therapy in ALL
often involves daily oral 6-
mercaptopurine ,weekly
methotrexate, and monthly Vincristine
and prednisone .
 -:Relapse phase
Children which ALL who experience a
bone marrow relapse while on
chemotherapy generally do less well
than children who relapse more thane
6months after completing their
specified course of therapy. It may
occur in any time.
Nursing intervention

 •Observe for increasing fatigue
,increasing HR ,increasing RR and
irritability.
 RBC transfusions can be given to
correct the anemia
 Observe for fever or other signs of
infection .
 Antibiotic therapy .
 Platelet transfusion to control such as
bleeding .
 •Assess the child and family member
for feeling of fear and anxiety .
 Emotional supports for the child and
family
 To control infection, place the pt in
private room.
 Reference s
 Family –centered “nursing care of
children”2nd edition .
 Pediatric nursing –incredibly easy-
LIPPINCOTT WILLIAMS & WILKINS .