Leukemia: Causes, Symptoms, Treatment, and Nursing Care

What is Leukemia

It is also referred to as cancer of the blood. Leukemia occurs as a result of malignant transformation of the stem cells of leukocytes (white blood cells) causing bone marrow production of immature white blood cells that cannot function properly.
It is also a malignant proliferation in the number of white blood cells at an immature stage in the bone marrow. It is a malignant disorder of blood and blood forming tissues (bone marrow, lymph system, and spleen) characterized by a proliferation of abnormal white blood cells in the body.
It occurs in all age groups.
Although it is often thought of as a disease of children, the number of adults affected are ten times that of children.

Causes of Leukemia

The actual cause is unknown (idiopathic)

Types of Leukemia

In general, leukemia are classified into acute (rapidly developing) and chronic (slowly developing) forms. In children, about 89% of leukemia are acute.

Acute leukemia is divided into Acute lymphocytic leukemia (ALL)and Acute myelogenous leukemia (AML), depending on whether specific white blood cells called lymphocytes or myelocytes (precursors of granulocytes, especially, neutrophils), which are linked to immune defenses, are involved.
Acute lymphocytic leukemia is more common in children and accounts for about 60% of all leukemia in children.

Acute myelogenous leukemia is more common in adults. Its incidence increases with aging. Chronic leukaemia can also be divided into Chronic lymphocytic leukemia(CLL)and Chronic myelogenous leukemia (CML)(chronic granulocytic leukemia). Chronic leukemia is rare in children.

Pathophysiology of Leukemia

It occurs as a result of a malignant transformation of the stem cells of white blood cells causing the bone marrow to produce large numbers of immature or abnormal white blood cells that cannot function normally.

These abnormal or immature white blood cells move into the bloodstream and gradually replace the normal or functional white blood cells. The immature white blood cells cannot perform their proper role of protecting the body against diseases since they are defective.

This makes the affected individual vulnerable to infections. As leukemia progresses, the cancer interferes with the bone marrow’s production of other types of blood cells, including red blood cells and platelets.
This results in anemia, thrombocytopenia and bleeding problems.

Signs and Symptoms of Leukemia

• Fever
• Weakness, fatigue, malaise
• Bleeding tendencies such as rectal bleeding, gum bleeding, epistaxis, petechiae etc.
• Headache
• Bone and joint pain
• Anorexia
• Frequent and unusual infections
• Pallor
• Anaemia
• Hepatomegaly
• Vomiting
• Splenomegaly
• Generalized lymphadenopathy or swollen lymph nodes
• When it infiltrates the central nervous system it can cause seizure, balance problems and abnormal vision

Diagnostic Investigations & Test of Leukemia

• Complete blood count for WBC count, thrombocytopenia, anaemia
• Bone marrow biopsy to reveal immature and abnormal lymphoblast
• CT scan of the head, abdomen, or chest shows metastasis
• Lumbar puncture/CSF for infiltration into the central nervous system
• Lymph node biopsy for lymph node examination

Medical Management of Leukemia

• Chemotherapy
• Radiation therapy
• Blood transfusion
• Bone marrow transplant
• Analgesic for pain
• Broad spectrum antibiotics to control infection

Intensive leukemia chemotherapy has certain side effects which include hair loss, nausea and vomiting, and increased risk for infection or bleeding in the short term, as well as other potential health problems.

Nursing Care of Leukemia

The aim of treatment is to prevent infection, improve appetite and prevent bleeding.

• Isolate patient or practice barrier nursing.
• Ensure adequate rest and sleep.
• Reassure patient and family.
• Monitor vital signs and record accurately.
• Restrict visitors and staff with possible. communicable diseases such as common cold, sore throat etc from coming into contact with patient.
• Provide frequent and meticulous oral hygiene to decrease infection from the oral cavity.
• Maintain personal hygiene.
• Use sterile gloves for invasive procedure such as setting intravenous line, catheterization etc.
• Provide daily care of cannula site.
• Avoid vaginal tampons.
• Provide foods high in protein and vitamins, nutritious, and easily digestible.
• Give mouth care before and after meals.
• Serve food in bits and frequently.
• Administer drugs and observe for their desired and side effects.
• Provide foods that are soft in texture.
• Serve food at warm temperature.
• Weigh patient daily and record.
• Encourage foods and fluids that are least irritating.
• Monitor intake and output chart.
• Remove all unpleasant stimuli before meals.
• Do not give intramuscular or subcutaneous injections.
• Avoid Aspirin and Aspirin containing medications.
• Do not insert indwelling catheters, do it gently if it becomes necessary.
• Avoid rectal temperature, suppositories and enema.
• Use stool softeners and oral laxative to prevent constipation and avoid straining with stool.
• Use smaller needles when performing venipuncture.
• Apply pressure to venipuncture sites for 5 minutes or until bleeding stopped.
• Permit no flossing of teeth and no commercial mouth washes.
• Use only soft bristled toothbrush for mouth care.
• Lubricate lips with lubricant every 2 hours to prevent cracks.
• Avoid suction, if at all possible. If unavoidable do gentle suction.
• Discourage vigorous coughing or blowing of the nose.
• Pad side rails as needed.
• Prevent falls by assisting patient to ambulate when necessary.
• Monitor patient for signs and symptoms of bleeding such as ecchymosis, petechiae, haematuria, melaena or epistaxis and report.
• Apply direct pressure to bleeding site.
• Apply cold compresses and direct pressure and elevate extremities if bleeding occurs.
• For epistaxis, position patient in high fowler’s position, apply ice pack to back of neck and direct pressure to nose.
• Notify physician when bleeding is prolonged and unable to stop within 10minutes.

Complications of Leukemia

Bleeding:This is a condition where the blood does not clot properly, causing symptoms such as bruising, nosebleeds, bleeding gums, and heavy menstrual periods. Bleeding can result from the leukemia cells reducing the number of platelets in the blood, or from the side effects of chemotherapy or radiation therapy that affect the bone marrow.

Infections:This is a condition where the body is unable to fight off harmful germs, causing symptoms such as fever, chills, cough, sore throat, and skin rashes. Infections can result from the leukemia cells impairing the function of the white blood cells, or from the side effects of chemotherapy or radiation therapy that lower the immune system.

Aneamia:This is a condition where the red blood cells are low, causing symptoms such as fatigue, weakness, shortness of breath, and pale skin. Anemia can result from the leukemia cells crowding out the normal blood cells in the bone marrow, or from the side effects of chemotherapy or radiation therapy.

Tumor lysis syndrome:This is a condition where the rapid breakdown of leukemia cells releases substances into the blood that can damage the kidneys, liver, heart, and nervous system. Tumor lysis syndrome can result from the effects of chemotherapy or targeted therapy that kill large numbers of leukemia cells at once.

Leukostasis:This is a condition where the high number of leukemia cells in the blood causes blockages in the small blood vessels, affecting the blood flow to vital organs. Leukostasis can result in symptoms such as confusion, dizziness, headache, blurred vision, chest pain, and difficulty breathing. Leukostasis is more common in acute leukemias than chronic leukemias.

Leukemia spread:This is a condition where the leukemia cells invade other parts of the body, such as the brain and spinal cord, skin, and gums. The specific complications a person can experience depend on where the cancer has spread. For example, cancer that spreads to the brain can cause problems with thinking and mood changes.