Acute Lymphocytic Leukemia

Eugenio, Jill Therese Caballero, Richelle Orario, Hazel Ann Iturralde, Ryan Vibora, Jonathan

DEFINITION:
A form of leukemia, or cancer of the white blood cells characterized by excess lymphoblasts. The word "acute" in acute lymphocytic leukemia comes from the fact that the disease progresses rapidly and affects immature blood cells, rather than mature ones. The "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia and acute childhood leukemia. Acute lymphocytic leukemia (ALL) occurs when the body produces a large number of immature white blood cells, called lymphocytes. The cancer cells quickly grow and replace normal cells in the bone marrow. Bone marrow is the soft tissue in the center of bones that helps form blood cells. ALL prevents healthy blood cells from being made. Life-threatening symptoms can occur.

RISK FACTOR:
Down syndrome or other genetic disorders. A brother or sister with leukemia.

INCIDENCE RATE:
63.6 percent were diagnosed under age 20 y/o. 22.2 percent died under age 20 y/o.

SIGNS & SYMPTOMS:

Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs Pinpoint red spots on the skin (petechiae) Swollen glands (lymphadenopathy) in the neck, under arms, and groin Night sweats

PATHOPHYSIOLOGY

Proliferation of WBC (blast)

Bone marrow depression

WBC

RBC

PLATELETS

Immune Function

Oxygen Capacity

Clotting Capacity

- Fever -Infection (pulmonary, Urinary, Blood infection)

- Weakness -Malaise - Pallor

-increase bruising/ petechiae -Nose Bleeding - Gum bleeding

DIAGNOSTIC PROCEDURES:
Physical examination and history. Complete blood count (CBC). Bone marrow aspiration and biopsy. Cytogenetic analysis. Immunophenotyping. Blood chemistry studies. Chest x-ray.

MEDICAL MANAGEMENT:
Chemotherapy

Radiation therapy - Bone Marrow transplant

 Surgery - Splennoctomy

NURSING MANAGEMENT:
Observe for increasing fatigue, increasing HR, RR, and irritability. RBC transfusions can be given to correct anemia. Antibiotic therapy Observe for fever and other signs of infection. Platelet transfusion to control bleeding. Assess the child and family member for feeling of anxiety. Emotional support for the child and family. Isolate the patient to avoid opportunistic infections.

DISCHARGE PLAN:
Medicines:  Always take your medicine as directed by your caregiver. If you think it is not helping or if you feel you are having side effects, call your caregiver. Do not quit taking it until you discuss it with your caregiver. If you are getting chemotherapy, it is important to take your medicine exactly as you are told.  Keep a written list of what medicines you are taking and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Ask your caregiver for information about your medicines. If you are taking antibiotics, take them until they are all gone even if you feel better. Follow-up visit information:  Keep all appointments. Write down questions you have about your illness and how it is treated. This way you will remember to ask these questions during your next visit. Diet:  It is important that you get good nutrition when you have cancer. Eat a variety of healthy foods from all the food groups. The food groups include breads, vegetables, fruits, milk and milk products, and protein (beans, eggs, poultry, meat and fish). Eating healthy foods may help you feel better and have more energy. You may need to make diet changes depending on your tolerance, the location of your cancer, or treatment side effects. For example, if you have trouble swallowing, try eating foods that are soft or in liquid form. Ask your caregiver if you should add special drinks or vitamins to your diet. Tell your caregiver if you are nauseated, vomiting, or have other problems eating or digesting your food. Rest:  You may feel like resting more. Match your activity to the amount of energy you have. Nap a couple of times during the day. Going to bed early and getting up late may also help. Exercise:  Exercising helps keep you healthy. Caregivers may tell you to decrease your activities while your blood cell count is low. Ask your caregiver to help you plan the best exercise program for you. Start exercising when your caregiver says it is OK. It is best to start slowly and do more as you get stronger.

STAGES:
y STANDARD (LOW) RISK:

Includes children between one to nine years old with with a white blood cell count of less than 50,000ml. at diagnosis
y HIGH RISK:

Includes children younger than one year old or older than nine with a white blood cell count of 50,000ml. and more at diagnosis.
y RECURRENT:

Refers to the leukemia that has recurred ( relapsed, came back ) after it was treated.