CHILDHOOD LEUKEMIA

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 INTRODUCTION
Leukemia is a greek word which means(
leukas= white + haima = blood)
It is a disease of abnormal proliferation
and maturation of bone marrow which
interferes with the production of normal
RBCs, WBCs and platelets.

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1.What is leukemia?
A.uncontrolled production of immature and
abnormal WBCs.
B.disease of abnormal proliferation and
maturation of RBCs ,WBCs and platelets.
C.blood cancer
All of the above

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Definition:- a malignant progressive disease in
which the bone marrow and other blood-forming
organs produce increased numbers of immature or
abnormal leucocytes. These suppress the
production of normal blood cells.

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 incidence

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 Types of leukemia
There are 2 main subtypes:- acute and
chronic

leukemia

acute
myeloid
lymphoid

chronic
Myeloid
lymphoid
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2.Acute nonlymphocytic
leukemia (ANLL) is also called-
A.acute myeloid leukemia
B.chronic myeloid leukemia
Myeloblastic lymphoma
Lymphocytic lymphoma

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TYPES DEFINITION INCIDENSE SYMPTOMS
ALL Bone marrow 1:2000 live birth Fever , malaise ,
elements are bone pain,
replaced by hepatomegaly
immature cell splenomegaly ,
petechie , purpura
, ecchymosis
CLL white blood cells Enlarged lymph
start forming in node.
the bone marrow
but then go into
the blood.
CML Myeloid cells 2-3% in childhood Splenomegaly ,
increased in all hepatomegaly.
stages both in
blood and bone
marrow

AML rapid growth of 20% childhood Anemia ,

abnormal WBC leukemia leucopenia ,
that accumulate in thrombocytopenia.
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interfere with the
Bone marrow elements are replaced by
immature cells
A. ALL
B. AML
C. CLL
D. CML

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 3.Exact cause of leukemia is not
clearly understood ,but some factors
are responsible EXEPT -

A.human T cell lymphoma virus (HTLV)

B.epistein barr virus
C.cytomegalovirus
D.HIV

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 PATHOPHYSIOLOGY

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 petechie
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 purpura

ecchymosis

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clinical manifestations (specific) which
is not present-

A. CNS involvement or meningeal

leukemia
B.hepatomegaly
C.lymphadenopathy
D.none of the above

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4.which is not a conformatory
diagnosis of leukemia-
A. bone marrow study
B. DNA markers
C.blood examination
D.doppler studies

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 management
Chemotherapy
Radiation therapy
Stem cell transplant
Bone marrow tranceplant

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Which procedure is can not doing as
management-

A. chemotherapy
B.radiation therapy
C.biopsy
D.bone marrow transplatation

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 CHEMOTHERAPY
Single agent or combination chemotherapy is
the treatment of choice for most types childhood
leukemia.
Some of the drugs used to treat childhood leukemia
include.

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Chemotherapic Route of Common side
administration
agents effects
asparginase In childrens it is allergic reaction
administered through an ,increased plasma
indwelling central ammonia level
catheter or implantable
port
cytarabine ................................. Nausea, vomiting,
headache , fever
daunorubicin .................................. Hair loss , red urine
,bone marrow
suppression
methotrexate .................................... Nausea , headache
elevated liver enzymes
cytoxan ..................................... Loss of appetite, gonadal
dysfunction ,BMS
vincristine ....................................... Hair loss , neuropathy ,
constipation
Mercaptopurine and Bone marrow suppresion
thioguanine
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 RADIATION THERAPY:- Radiation
therapy uses high-energy radiation to kill
cancer cells. It is not always needed to
treat leukemia.
spread of leukemia to the brain or treat the
testicles
Tumor that is pressing on the trachea
Radiation to the whole body is often an
important part of treatment before a bone
marrow or peripheral blood stem cell
transplant .........WHY?
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 Stem cell transplant
A stem cell transplant (SCT) can
sometimes be used for children whose
chances of being cured are poor with
standard or even intense chemotherapy.

WHY SCT USE AFTER GIVEN

CHEMOTHERAPY?

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 Bone marrow transplant
Bone marrow transplant (BMT) is the
treatment of choice for all types of
leukemia.

BMT have two major categories

Allogenic BMT
Autologous BMT

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 leukemia can be cured by

A.bone marrow transplantation

B.radiation therapy
C.intravenous antibiotic therapy
D. Combination of all of the above

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 NURSING ASSESSMENT
Obtain a history
Perform a physical examination,including:
Examination of skin
Palpation of spleen and liver enlargement
Inspection of skin for areas of infection
including indwelling catheter sites
Monitor vital signs

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 NURSING DIAGNOSIS

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 Risk of infection and hemorrhage related
to bone marrow suppression caused by
chemotherapy and disease.
Goal:- preventing infection and
hemorrhage
Monitor CBC as ordered
Provide adequate hydration
Observe renal function carefully
Protect the child from infection sources.
Observe the child closely and be alert for
signs
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 Acute pain related to diagnostic
procedures, progression of disease and
adverse effect of treatment.
Goal :- relieving pain
Position the child for comfort
Assess the childs pain using a pain scale
in regular intervals
Administer drugs on a preventive shedule
before pain becomes intense.continuos
infusion pumps for opioid administration
are commonly used.
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 Activity intolerance related to fatigue that
result from the disease and treatment.
Goal:- conserving energy
Assess the childs energy level and space
needed activities accordingly .
Encourage the child to limit strenuous
activity after such diagnostic procedures
as bone marrow aspiration and spinal
taps.

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 Anxiety of parents related to learning of
diagnosis
Goal:- decreasing parentral anxiety
Be avilable to the parents
Offer kindness, concern ,consideration ,and
sincearity toward childnand parents
Offer hope that therapy will be effective and will
prolong life
Encourage the parents and ask about help for
interventions
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 Home care considerations
Begin to develop home care plan before
the child leaves the hospital
Arrange schedule for blood draws and
how results will be managed
Collaborate with primary care provider
regarding to immunization
Make sure that parents or caregivers can
demonstrate the proper technique for
venous assess , such as dressing flushing
and assessing for infection
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 Family education
Instruct parents about leukemia and
adverse effect of chemotherapy
Tell to parents cheak regularly
temperature with thermometer
Tell parents to call health care provider if
childs fever of more than 101 F*
Teach preventive measures such as
handwashing and isolation from children
with communicable diseases.
Reinforce that parents are never to use a
rectal thermameter.
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Which drug are NOT cause bone
marrow suppresion

Vincristine
Daunorubicine
Thioguanine
Mercaptopurine

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acute myeloid leukemia has
how much classification-

A.M5
B.M4
C.M7
D.M3
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