Haematology Module:

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Adult Medical-Surgical Nursing

• Haematology Module
• Leukaemia 2

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Leukaemia Description

• A group of malignant disorders affecting
• White blood cells (lymphocytes or leucocytes)
• Bone marrow
• Lymph system
• Spleen
• (Introduction in Lecture 1)

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Leukaemia Classification

• Acute Myelogenous Leukaemia (AML) (Lecture 1)
• Acute Lymphocytic Leukaemia (ALL)
• Chronic Myelogenous Leukaemia (CML)
• Chronic Lymphocytic Leukaemia (CLL)

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• Acute Lymphocytic Leukaemia

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Acute Lymphocytic Leukaemia (ALL)

• Only 15 of adult leukaemia
• Most common leukaemia of childhood
• Acute onset
• Good remission and cure rate in children but not
  adults

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ALL Pathophysiology

• Lymphoblasts (immature dysfunctional lymphocytes)
  proliferate in the blood and bone marrow
• Lymphoblasts frequently pass to the central
  nervous system (CNS) across the blood-brain
  barrier
• Treatment involves intra-thecal chemotherapy
  (into the cerebrospinal fluid via lumbar
  puncture)

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ALL Clinical Manifestations

• Sudden onset
• High susceptibility to infection
• Prone to opportunistic infection (as Candida
  Albicans)
• Fatigue
• Pallor
• Bleeding tendency
• Bone pain damaged overcrowded marrow

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ALL Diagnosis

• CBC
• Blood film
• Extremely increased number of immature white
  cells (lymphoblasts)
• ? RBC and platelets
• Bone marrow biopsy crowding of lymphoblasts
• Lumbar puncture and CT scan for evidence of
  leukaemia outside blood or bone marrow

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ALL Management

• Intensive chemotherapy including intrathecal
• Destroys rapidly dividing blast cells
• (Chemotherapy included in Leukaemia Lecture 1)

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ALL Prognosis

• ALL is more prevalent in childhood
• Poor prognosis for adults (lt25 achieve 5-year
  continuous remission)
• Good cure rate (50-75) in children

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• Chronic Myelogenous Leukaemia

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CML Description

• A chronic malignancy of granulocytes (mature
  cells, not blast cells)

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CML Pathophysiology

• Related to radiation
• A stem cell disorder where there is a
  translocation of genetic material from C22 the
  Philadelphia chromosome? C9
• Dysfunctional granulocytes of all stages are
  increased in blood and bone marrow
• Marked splenomegaly extramedullary (site other
  than bone marrow) haematopoiesis/ infiltration

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CML Clinical Manifestations

• Gradual onset
• Chronic fatigue and weakness
• Pallor
• Weight loss
• Compromised immune response
• Splenomegaly
• Anaemia
• Bleeding tendency

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CML Diagnosis

• Patient history and clinical picture
• CBC
• Chromosome studies
• Bone marrow biopsy
• Granulocytes of all stages in peripheral blood
  and bone marrow
• WCC gt100, 000/ cmm3 (ref. 5-10,000)
• Reduced thrombocyte and red cell count

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CML Management

• Less intensive treatment
• (Resistant to intensive chemotherapy which is
  aimed at dividing cells)
• Steroids
• Oral chemotherapy
• Blood transfusions
• (Maybe splenectomy)

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CML Prognosis

• Poor prognosis (more serious than CLL)
• Death from infection or haemorrhage
• Often becomes acute as AML

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• Chronic Lymphocytic Leukaemia

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CLL Description

• A gradual accumulation of small dysfunctional
  lymphocytes in
• Blood circulation
• Bone marrow
• Lymph nodes
• Spleen

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CLL Pathophysiology

• Non-functioning leukaemic B-cells accumulate
  slowly in bone marrow, spleen, liver, lymph nodes
• Lymphocytosis in circulation
• Immunoglobulins non-functioning
• Impaired immune response
• Anaemia
• Thrombocytopaenia

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CLL Hairy Cell Leukaemia

• Hairy Cell Leukaemia hairy appearance of
  lymphocytes
• These are intensively destroyed by the spleen
• ? splenomegaly
• Pancytopaenia ? acute infection risk

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CLL Clinical Manifestations

• Gradual onset
• Chronic fatigue and weakness
• Pallor
• Weight loss
• Compromised immune response
• Splenomegaly, lymphadenopathy
• Anaemia
• Bleeding tendency

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CLL Diagnosis

• Patient history and clinical picture
• CBC, bone marrow biopsy
• Lymphocytosis
• WCC gt100, 000/ cmm3 (ref. 5-10,000)
• Dysfunctional lymphocytes of all stages in
  peripheral blood and marrow
• Presence of Hairy Cell lymphocytes

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CLL Management

• Splenectomy (reduce haemolysis)
• Steroids
• Oral chemotherapy
• (Resistant to intensive chemotherapy which is
  aimed at dividing cells)
• Supportive blood transfusions

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CLL Prognosis

• Eventually blast crisis ? ALL
• Infection
• Haemorrhage
• Death (survival approximately 7 years)