Tests That Examine The Blood And Bone Marrow Are Used To Diagnose Childhood All
The following tests and procedures may be used to diagnose childhood ALL and find out if leukemia cells have spread to other parts of the body such as the brain or testicles:
- Physical exam and health history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Complete blood count with differential: A procedure in which a sample of blood is drawn and checked for the following:
- The number of red blood cells and platelets.
- The number and type of white blood cells.
- The amount of hemoglobin in the red blood cells.
- The portion of the sample made up of red blood cells.
Assessment And Diagnostic Findings
The diagnosis of ALL can be confirmed with a combination of the following:
- Bone marrow aspiration. Typical clinical findings and bone marrow aspirate showing a proliferation of immature WBCs confirm ALL.
- Bone marrow biopsy. A bone marrow biopsy, usually of the posterior superior iliac spine, is part of the diagnostic workup.
- Blood counts. Blood counts show severe anemia, thrombocytopenia, and neutropenia.
- Differential leukocyte count. Differential leukocyte count determines cell type.
- Lumbar puncture. Lumbar puncture detects meningeal involvement.
- Uric acid levels.Elevated uric acid levels and lactic dehydrogenase levels are commonly found.
Typical Treatment Of Acute Lymphocytic Leukemia
in adults. To learn about ALL in children, see Leukemia in Children.)
The main treatment for acute lymphocytic leukemia in adults is typically long-term chemotherapy . In recent years, doctors have begun to use more intensive chemo regimens, which has led to more responses to treatment. But these regimens are also more likely to cause side effects, such as low white blood cell counts. Patients may need to take other drugs to help prevent or treat these side effects.
Treatment typically takes place in 3 phases:
- Induction
- Consolidation
- Maintenance
The total treatment usually takes about 2 years, with the maintenance phase taking up most of this time. Treatment may be more or less intense, depending on the subtype of ALL and other prognostic factors.
ALL can spread to the area around the brain and spinal cord. Sometimes this has already occurred by the time ALL is first diagnosed. This spread is found when the doctor does a lumbar puncture and leukemia cells are found in the cerebrospinal fluid , the liquid that surrounds the brain and spinal cord. The treatment of this is discussed below.
Even if leukemia cells aren’t found in the CSF at diagnosis, it’s possible that they might spread there later on. This is why an important part of treatment for ALL is central nervous system prophylaxis treatment that lowers the risk of the leukemia spreading to the area around the brain or spinal cord. This is also described in more detail below.
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Safety Precautions For Household Members
The family and friends of people living with leukemia should take precautions to keep the individual as healthy as possible.
Individuals with cancer, especially those undergoing chemotherapy, are immunocompromised, meaning that they have a weakened immune system. If a person with leukemia becomes unwell, their immune system cannot effectively combat the infection. As a result, they could become extremely ill.
People sharing a household with someone who has leukemia should get the flu shot. They should not receive the nasal spray vaccine because it contains a live virus that could put the immunocompromised person at risk.
Additionally, people in the household should follow basic hygiene protocols, such as washing their hands frequently and avoiding close contact with people who are unwell.
If anyone in the household has signs of infection, it is important to contact the persons healthcare team immediately.
How Is Acute Lymphoblastic Leukemia Treated
Chemotherapy
Most kids with ALL will get chemotherapy. These are special drugs that kill cancer cells. Which drugs a child gets and in what combination depends on the subtype of ALL and how fast-moving the disease is. How cancer cells respond to the first treatment helps doctors decide how to choose the next type of chemo.
Different types of chemo can be given:
- as an injection into a muscle
- with a spinal tap right into the cerebrospinal fluid
The treatment goal is remission, which is when tests don’t find any cancer cells in the body. Then, maintenance chemotherapy keeps the child in remission and prevents the cancer from coming back. Kids get maintenance chemo for 2 to 3 years.
Stem Cell Transplants
Some kids who have a fast-growing type of ALL might need a stem cell transplant . This treatment involves:
- killing cancer cells, normal bone marrow, and immune system cells with high-dose chemotherapy and/or radiation
- putting healthy donor stem cells back into the body
- rebuilding a healthy blood supply and immune system with the new stem cells
Other treatments may include:
- radiation therapy: high-energy X-rays that kill cancer cells
- targeted therapy: specific drugs that find and attack cancer cells without hurting normal cells
- immunotherapy: medicine that uses the childs own immune system to get rid of cancer cells
Clinical Trials
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Response Rates To All Treatment
In general, about 80% to 90% of adults will have complete remissions at some point during these treatments. This means leukemia cells can no longer be seen in their bone marrow. Unfortunately, about half of these patients relapse, so the overall cure rate is in the range of 40%. Again, these rates can vary a lot, depending on the subtype of ALL and other prognostic factors. For example, cure rates tend to be higher in younger patients.
What If The Leukemia Doesnt Respond Or Comes Back After Treatment
If the leukemia is refractory that is, if it doesnt go away with the first treatment then newer or more intensive doses of chemo drugs may be tried, although they are less likely to work. Immunotherapy may be an option for patients with B-cell ALL. A stem cell transplant may be tried if the leukemia can be put into at least partial remission. Clinical trials of new treatment approaches may also be considered.
If leukemia goes into remission with the initial treatment but then comes back , it will most often do so in the bone marrow and blood. Occasionally, the brain or spinal fluid will be the first place it recurs.
In these cases, it is sometimes possible to put the leukemia into remission again with more chemotherapy , although this remission is not likely to last. The approach to treatment may depend on how soon the leukemia returns after the first treatment. If the relapse occurs after a long interval, the same or similar treatment may be used to try for a second remission. If the time interval is shorter, more aggressive chemo with other drugs may be needed.
Immunotherapy might be another option for some patients. For example, a monoclonal antibody or CAR T-cell therapy might be an option for some people with B-cell ALL.
ALL patients with the Philadelphia chromosome who were taking a targeted drug like imatinib are often switched to a different targeted drug.
For patients with T-cell ALL, the chemo drug nelarabine may be helpful.
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Pearls And Other Issues
Despite improvements in supportive care, death resulting from treatment toxicity remains a challenge. It is important to watch out for Tumor Lysis Syndrome which occurs when chemotherapy causes cancer cells to lyse releasing certain intracellular elements such as potassium, calcium, uric acid, and phosphorus. These elements, in large numbers, resulting in toxicity that can often lead to renal failure. Pretreatment with fluids and steroids typically prevents Tumor Lysis Syndrome. However, if it occurs, aggressive fluid therapy is the treatment.
Even after treatment, Acute Lymphocytic Leukemia can come back . Relapses can occur as far back as 21 years. IT is important to address other issues associated with cancer treatment in a young child including providing psychological support to child, parents, and family.
What Is Acute Lymphocytic Leukemia
Acute leukemias have large numbers of immature leukocytes and overproduction of cells in the blast stage of maturation.
- Acute lymphocytic leukemia , also known as acute lymphoblastic leukemia, refers to an abnormal growth of lymphocyte precursors or lymphoblasts.
- Acute leukemia is a malignant proliferation of white blood cell precursors in bone marrow or lymph tissue, and their accumulation in peripheral blood, bone marrow, and body tissues.
- About 20% of leukemias are acute.
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What Foods And Meals Are Best
People with leukemia may find that eating a healthy, balanced diet helps them stay strong during and after the treatment and boosts their ability to tolerate any side effects. The body also needs good nutrition to help it replace the blood cells and tissues that chemotherapy has damaged.
A balanced diet includes:
- plant-based oils, such as olive oil
- low fat dairy
- whole grains
In addition to getting plenty of the above foods, people should limit their intake of saturated and trans fats, sugar, salt, and alcohol.
It is also important to maintain hydration by drinking enough water, tea, and nonsugary drinks. Water may help alleviate chemotherapy side effects such as constipation and fatigue. It may also help people rehydrate after vomiting.
If someones symptoms include diarrhea or acid reflux, they should consider noncaffeinated beverages.
Although the food that a person eats cannot treat cancer, it can make a difference to their health and how they feel.
Leukemia Nursing Care Plan
Leukemia is a type of cancer which affects the blood cells. This entails the proliferation of abnormal immature white blood cells. These cells are accumulated in the lymphoid tissues and bone marrow, and when a person have leukemia it reproduce uncontrollably and infiltrate the body tissues and blood vessels. This will eventually lead to malfunction due to hemorrhage, encroachment, or infection. This can be further classified as acute, which is rapidly growing or chronic, which develops more gradually.
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Desired Outcomes/evaluation Criteriapatient Will:
- Identify negative factors affecting activity tolerance and eliminate or reduce their effects when possible.
- Use identified techniques to enhance activity tolerance.
- Participate willingly in necessary/desired activities.
- Report measurable increase in activity tolerance.
- Demonstrate a decrease in physiological signs of intolerance .
- Desired Outcomes/Evaluation
Desired outcomes/evaluation criteriapatient will:
- Participate in learning process.
- Identify interferences to learning and specific action to deal with them.
- Exhibit increased interest/assume responsibility for own learning by beginning to look for information and ask questions.
- Verbalize understanding of condition/disease process and treatment.
- Identify relationship of signs/symptoms to the disease process and correlate symptoms with causative factors.
- Perform necessary procedures correctly and explain reasons for the actions.
- Initiate necessary lifestyle changes and participate in treatment regimen.
Treatment Of Childhood Acute Lymphoblastic Leukemia
For information about the treatments listed below, see the Treatment Option Overview section.
The treatment of newly diagnosed standard-risk childhood acute lymphoblastic leukemia during the remission induction, consolidation/intensification, and maintenance phases always includes combination chemotherapy. When children with a poor response to treatment are in remission after remission induction therapy, a stem cell transplant using stem cells from a donor may be done. When children with a poor response to treatment are not in remission after remission induction therapy, further treatment is usually the same treatment given to children with high-risk ALL.
Intrathecal chemotherapy is given to prevent the spread of leukemiacells to the brain and spinal cord.
Treatments being studied in clinical trials for standard-risk ALL include combination chemotherapy with or without targeted therapy with a monoclonal antibody .
Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.
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Parent And Patient Characteristics
Of 35 families who met eligibility criteria during the study recruitment period, 23 were approached. A total of N =22 families were consented and enrolled for a 95.6% participation rate. One patient relapsed after enrollment and both the patient and parent were removed from the study sample. A total N =21 patients and N =24 parents completed T1. An additional patient and parent were lost to follow-up after T1. Overall, N =20 families participated over the course of all three study time points for a retention rate of 90.9% .
All parents were between 30 and 49years old, 54.2% had a college degree, and most had an income of $60,000 or more . Mothers comprised 75% of participating parents. Parents and patients were largely white and residents of urban areas . All patients were insured . Patients ranged from 3 to 18years old and the largest group was between 7 and 12years old at T1 . Most were diagnosed with ALL ages 6 and under .
Table 1 Parent and patient characteristics at T1
Practice Test: Acute Lymphocytic Leukemia
Here are some practice questions for this study guide. Please visit our nursing test bank page for more NCLEX practice questions.
1. Which of the following would the nurse identify as the initial priority for a child with acute lymphocytic leukemia?
A. Instituting infection control precautions.B. Encouraging adequate intake of iron-rich foods.C. Assisting with coping with chronic illness.D. Administering medications via IM injections.
1. Answer: A. Instituting infection control precautions.
Acute lymphocytic leukemia causes leukopenia, resulting in immunosuppression and increasing the risk of infection, a leading cause of death in children with ALL, therefore, the initial priority nursing intervention would be to institute infection control precautions to decrease the risk of infection.
- Option B: Iron-rich foods help with anemia, but dietary iron is not an initial intervention.
- Option C: The prognosis of ALL usually is good. However, later on, the nurse may need to assist the child and family with coping since death and dying may still be an issue in need of discussion.
- Option D: Injections should be discouraged, owing to increased risk ofbleeding due to thrombocytopenia.
2. Which of the following complications are three main consequences of leukemia?
A. Bone deformities, spherocytosis, and infection.B. Anemia, infection, and bleeding tendencies.C. Lymphocytopoiesis, growth delays, and hirsutism.D. Polycythemia, decreased clotting time, and infection.
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What You Need To Know:
Acute lymphoblastic leukemia is cancer that affects the blood and bone marrow. The bone marrow makes white blood cells , red blood cells , and platelets. WBCs help fight infection. RBCs help carry oxygen throughout the body. Platelets help the blood clot. ALL causes your body to make too many immature white blood cells . These cells are cancer cells, and cannot fight infection like healthy WBCs. Cancer cells crowd the bone marrow and prevent it from making healthy blood cells. Without enough healthy blood cells, you are at risk for infection, bleeding, and anemia. Anemia is a low level of red blood cells.
Nursing Care Of A Patient With B
Case Presentation
Chief complaint: Generalized arthralgia for 5 months.
History of present illness: A 35-year-old Hispanic man presented in November 2009 with generalized arthralgias that progressed to continuous shoulder and knee pain. Primary care physician evaluation revealed the complete blood count to be abnormal: complete blood count revealed a white cell count of 83,000/L, a hemoglobin count of 17.9 g/dL, and a platelet count of 155/L. In addition, biopsy revealed hypercellular bone marrow with involvement by a B-cell lymphoblastic leukemia. He was referred for emergent evaluation by a hematologist.
Flow cytometry revealed 80% to 90% abnormal cells expressing CD34, CD19, dim CD22, CD10, TdT, CD38, and HLA-DR, CD20. Fluorescence in situ hybridization for the Philadelphia chromosome fusion protein was negative. Full cytogenetics revealed a male karyotype with a translocation between the long arm of chromosome 1 and the short arm of chromosome 9 and addition to the long arm of chromosome 13 was observed in 6 metaphases. Five metaphases showed t unbalanced translocation between the long arm of chromosome 1 and the short arm of chromosome 19. Three metaphases showed t and dert. Six metaphases showed a normal male karyotype. The t is reported to be associated with B-cell acute lymphoblastic leukemia . Translocations resulting in partial deletion of the short arm of chromosome 9 also are reported in ALL. The final diagnosis was B-ALL.
Nursing Interventions
Reference
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Causes And Risk Factors Of Leukemia
Currently, the exact cause of leukemia is unknown. As with other types of cancer, leukemia is believed to develop from various factors in both of a persons genetic makeup and his or her environment.
The combination of these factors cause changes called mutations in the genetic material of the blood cells, causing them to grow and divide immaturely and rapidly.
These abnormal blood cells crown the bone marrow, which lead to the decreased production of healthy blood cells.
The risk factors for leukemia include:
- Family history of leukemia
- Poor quality of life