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Leukemia | 마이메르시 MyMerci
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Leukemia

NCLEX Review Guide: Leukemia

Pathophysiology & Types

Understanding Leukemia

  • Leukemia is a malignant disorder of blood-forming tissues characterized by uncontrolled proliferation of abnormal white blood cells. These immature cells crowd out normal blood cells, leading to decreased production of functional WBCs, RBCs, and platelets.
  • Classification is based on cell type (lymphoid vs. myeloid) and disease progression (acute vs. chronic).

Types of Leukemia

TypeAge GroupProgressionKey Features
ALL (Acute Lymphoblastic)Children 2-10 yearsRapidBest prognosis in children
AML (Acute Myelogenous)Adults >60 yearsRapidMost common acute leukemia in adults
CLL (Chronic Lymphocytic)Adults >55 yearsSlowMost common leukemia overall
CML (Chronic Myelogenous)Adults 40-60 yearsSlow initiallyPhiladelphia chromosome positive

Key Points

  • Acute leukemias require immediate treatment due to rapid progression
  • Chronic leukemias may be asymptomatic for years
  • ALL has the best prognosis in pediatric patients

Clinical Manifestations

Signs & Symptoms

  • Anemia symptoms: Fatigue, weakness, pallor, dyspnea due to decreased RBC production and crowding by leukemic cells.
  • Thrombocytopenia symptoms: Easy bruising, petechiae, bleeding gums, nosebleeds due to decreased platelet production.
  • Neutropenia symptoms: Frequent infections, fever, delayed wound healing due to decreased functional WBC production.
  • Leukostasis: High WBC count (>100,000) causing CNS symptoms, respiratory distress, and priapism in acute leukemias.

Clinical Scenario

A 25-year-old patient presents with fatigue, frequent nosebleeds, and recurrent infections over the past month. Lab results show WBC 75,000, Hgb 7.2, platelets 15,000. This presentation suggests acute leukemia requiring immediate intervention.

Memory Aid: "FAINT"

  • Fatigue (anemia)
  • Anemia symptoms
  • Infections (neutropenia)
  • Nosebleeds/bleeding
  • Thrombocytopenia signs

Key Points

  • Symptoms result from bone marrow failure, not the leukemic cells themselves
  • Fever may indicate infection OR disease process
  • Lymphadenopathy and splenomegaly are common

Nursing Management

Priority Nursing Interventions

PRIORITY: Infection prevention is the #1 nursing priority due to neutropenia
  1. Implement neutropenic precautions: Private room, hand hygiene, limit visitors, avoid fresh flowers/fruits
  2. Monitor for bleeding: Check platelet count, assess for petechiae, avoid invasive procedures when possible
  3. Prevent injury: Soft toothbrush, electric razor, fall precautions, avoid contact sports
  4. Monitor vital signs: Temperature q4h, report fever >100.4°F immediately

Clinical Priority

Patient with AML develops fever of 101.2°F. This is a medical emergency requiring immediate blood cultures, broad-spectrum antibiotics, and physician notification due to neutropenia.

Key Points

  • Neutropenic fever is an oncologic emergency
  • Avoid rectal temperatures, suppositories, and IM injections
  • Transfusion support may be needed for severe anemia/thrombocytopenia

Treatment & Complications

Chemotherapy & Side Effects

  • Induction therapy aims to achieve remission by destroying leukemic cells, followed by consolidation and maintenance phases.
  • Tumor lysis syndrome occurs when rapid cell destruction releases intracellular contents, causing hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia.
  • Disseminated intravascular coagulation (DIC) may occur, especially in acute promyelocytic leukemia (APL).
Monitor for tumor lysis syndrome: decreased urine output, cardiac arrhythmias, seizures, muscle cramps

Tumor Lysis Syndrome: "HUNK"

  • Hyperkalemia
  • Uric acid elevation
  • Nitrogen (BUN) elevation
  • Kidney dysfunction

Key Points

  • Allopurinol prevents uric acid nephropathy
  • Aggressive hydration helps prevent tumor lysis syndrome
  • Bone marrow transplant may be curative for some patients

Commonly Confused Concepts

Leukemia vs. Lymphoma

FeatureLeukemiaLymphoma
Primary LocationBone marrow/bloodLymph nodes
Circulating CellsAlways presentMay or may not be present
Bone MarrowAlways involvedMay be involved later
PresentationSystemic symptomsLocalized lymphadenopathy initially

Study Tips

  • Remember: Leukemia = "liquid tumor" (blood/bone marrow)
  • Lymphoma = "solid tumor" (lymph nodes/organs)
  • Both can cause similar systemic symptoms in advanced stages

Quick Check

Self-Assessment

  • ☐ Can you identify the four main types of leukemia and their characteristics?
  • ☐ Do you understand why infection prevention is the priority nursing intervention?
  • ☐ Can you recognize signs and symptoms of tumor lysis syndrome?
  • ☐ Do you know the difference between leukemia and lymphoma?
  • ☐ Can you explain why neutropenic fever is an emergency?
Common Pitfall: Don't confuse high WBC count with good immune function - leukemic cells are non-functional!

Remember: You're preparing to save lives! Every concept you master brings you closer to becoming an exceptional nurse. Stay focused, stay positive, and trust your preparation!

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