LEUKIMIA

Leukemia is a malignant disease in hematopoietic tissue characterized by the

replacement of normal bone marrow elements by abnormal blood cells or leukemic
cells. This is caused by uncontrolled proliferation of immature blood cell clones from
hematopoietic stem cells. These leukemic cells are also found in peripheral blood and
often invade reticuloendothelial tissue such as the spleen, liver and lymph glands.

Sign and Symptoms

1. The typical symptoms are pallor, heat and bleeding (bleeding and anemia are the
main manifestations).
2. Lymphadenopathy and hepatosplenomegaly

This is because extramedular is also involved (cancer cells spread throughout so that
lymph, liver and spleen increase white blood cell production).

3. Symptoms that are not typical are joint pain or bone pain that can be misinterpreted
as rheumatic disease.
4. Disorders of the central nervous system
Headaches, vomiting, seizures and vision problems can occur.
5. Other symptoms
Leukemia in body tools such as purpuric lesions on the skin, pleural effusion,
seizures in cerebral leukemia. Leukemia bleeding can be ecchymosis, petechiae,
gastrointestinal bleeding. Clinical manifestations that can be seen or reported by
clients or families directly:
a. Colds don't heal
b. Pale, lethargic, easily stimulated
c. Fever, anorexia
d. Weight loss
e. Ptechie, bruises without cause
f. Pain in bones / joints
g. Abdominal pain
 h. Anemia
i. Blood is hard to freeze
j. Frequent bleeding such as nosebleeds, bleeding gums, or bruises
k. Susceptible to infection
l. Pain in the joints or in the spine
m. Intense headaches
n. Appetite decreases
o. Experience drastic weight loss
p. Excessive sweat appears at night

Nursing Interventions

1. Nutritional therapy
a. Complete the nutritional assessment as needed
b. Monitor food / liquid intake and calculate daily calorie input as needed
c. Monitor appropriate laboratory results
d. Give patients and families written examples of recommended diets
e. Give oral care before eating or drinking
2. Monitor Nutrition
a. Weigh the patient's weight
b. Monitor for nausea and vomiting
c. Mental status monitoring (confused, depressed and anxious)
d. Review other sources of money related to nutritional status data
e. Perform laboratory checks (eg Hb, Ht, cellular immunity, electrolyte values
and so on)
3. Nutrition protection
a. Monitor vulnerability to infection
b. Increase adequate nutritional intake
c. Teach patients and families about signs and symptoms of infection and
when to report it to health care providers
d. Report positive culture to infection control personnel.
4. Reduction of bleeding:
a. Identification of causes of bleeding
b. Monitor the patient for severe bleeding
c. Pay attention to hemoglobin / hematocrit levels before and after blood loss
d. Instruct patients on activities
e. Instruct patients and families for signs of bleeding and appropriate action.

Farmakologi

1. Blood transfusion : Usually given if the Hb level is <6 gr%. In severe

thrombocytopenia and massive bleeding, platelet transfusions can be given, if there
is a sign that DIC can be heparin.
2. Corticosteroids: (prednisone, cortisone) dexamethasone and so on. after achieving
remission dons are reduced little by little and finally stopped.
3. Sitostatics: Generally sitostatica is given in combination together with prednisone.
Securities; alopecia, stomatitis, leucopenia, secondary infection (candidiasis). If the
leukocyte level of <2000 / m3 administration must be careful.
4. Imonotherapy: A new method of treatment, immunotherapy is given if remission
has been achieved and the number of leukemia cells is quite low (105-106).
5. Chemotherapy
There are 3 phases of chemotherapy:
a. Induction phase: Begins 4-6 mg after diagnosis is made. This phase is given:
corticosteroids (Prednisone), vincritine, and L-asparaginase. This phase is
declared successful if the signs of disease are reduced or no number of
young cells is found <5% in the spinal cord.
b. Central nervous system prophylactic phase: Methotrexate, cytrabine and
hydrocortisone through intrathecal therapy are given in this phase to prevent
leukemia cell invasion of the brain. Cranial irradiation therapy is performed
only in leukemia patients who experience central nervous system disorders.
c. Consolidation: In this phase a combination of treatments is carried out to
maintain remission and reduce the number of leukemia cells circulating in
 the body. Periodically complete blood tests are carried out to assess bone
marrow response to treatment. If bone marrow suppression occurs, the
treatment is stopped temporarily or the position of the drug is reduced.
6. Treatment at home
a. Exercise regularly
b. Discipline follows a healthy lifestyle
c. Avoid herbicides, pesticides and insecticides
d. Avoid radiation exposure
e. Eat healthy food and drink plenty of water
f. Take medication regularly according to what your doctor prescribes
7. Drug therapy
Arsenic trioxide and the all-trans retinoic acid (ATRA) drug