Lippincott Certification Review Medical-Surgical Nursing

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Chapter 8

Leukemia

●● Description ●● Leukemias are a group of malignant disorders of the hematopoietic system and are characterized by the uncontrolled proliferation of immature WBCs. ●● Leukemias are classified by onset and severity of symptoms (acute or chronic) and by the precursor cell (myeloid or lymphoid) involved in the formation of the abnormal cells (National Cancer Institute [NCI], 2023a) (see Types of leukemia, page 128). ●● Although the cause of leukemia is unknown, it has been linked to genetic damage to bone marrow cells, which transforms normal cells into malignant cells—chronic exposure to chemicals such as benzene, use of drugs that cause aplastic anemia, radiation exposure, and chemotherapy; it is also linked to Down syndrome and other chromosomal abnormalities. ●● Leukemia causes uncontrolled WBC (leukocyte) proliferation that interferes with the production of other cells, leading to thrombocytopenia and anemia; the immature leukocytes decrease immunocompetence and increase susceptibility to infection. ●● Signs and symptoms ●● Patients with acute or chronic leukemia may report vague signs and symptoms, such as fatigue, malaise, petechiae, night sweats, bone or joint pain, and weight loss. ●● Acute leukemia produces anemia, bleeding, and symptoms of infection such as sudden onset of high fever. ●● Hepatosplenomegaly and lymphadenopathy may also be present; chronic leukemia causes milder anemia and splenomegaly; however, many patients are asymptomatic at the time of diagnosis. ●● Additional signs and symptoms depend on the organ or tissue involved—for example, central nervous system involvement may cause headache and vomiting. ●● Diagnosis and treatment ●● Diagnosis is usually based on a CBC with differential and bone marrow aspirate that reveal leukemic blast cells. ●● Phased chemotherapy and targeted therapy, with or without stem cell transplantation, is standard treatment for leukemia (see Nursing implications in oncology care , pages 348–354). ●● Radiation and immunotherapy are also used to augment leukemia treatment. ●● Patients with low-risk chronic lymphocytic leukemia may not receive treatment if they are asymptomatic. ●● Stem cell transplantation is used to treat leukemia. ●● In allogenic transplantation , donor stem cells are transplanted into the patient. ●● Before transplantation, the patient undergoes chemotherapy and sometimes radiation to eliminate the leukemic cells; these procedures destroy all the patient’s bone marrow in preparation for grafting from the donor. ●● The principal complication of this type of transplantation is graft-versus-host disease, a type of organ rejection in which the transplanted cells reject the patient. ●● Autologous transplantation is an alternative method where the patient’s own stem cells are harvested during remission; these cells are then treated to remove residual tumor cells and reinfused after the patient undergoes immunosuppressant chemotherapy and radiation therapy; this method can help to avoid graft versus host disease because the patient receives their own cells.

●● Blood component transfusions may be necessary to treat severe thrombocytopenia, leukopenia, and anemia resulting from the disease process or from treatment (see Blood and plasma transfusion compatibility, page 128). ●● Most RBC transfusions involve 250 to 300 mL/unit of packed RBCs; whole blood is seldom transfused to treat leukemia. ●● The blood must be refrigerated until it is used. ●● The nurse must: ●● Verify the provider order. ●● Ensure appropriate IV size (18G) for blood administration. ●● Educate the patient regarding the procedure. ●● Check crossmatching and blood typing and the blood product with at least one other licensed nurse based on facility policy. ●● Take baseline vital signs before transfusion, and monitor cardiac status before and during transfusion. Copyright © 2025 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited.