Page 218 - Critical Care Notes

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HEMA/
ONCO

Leukemia
Leukemia is the uncontrolled neoplastic reproduction of WBCs. Causes include sig-
nificant bone marrow damage that can result from radiation, drugs, or chemicals.
Genetic, viral, and environmental factors also play a role in developing leukemia.
Pathophysiology
Myeloid Leukemia
■ Acute: Malignant alterations in hematopoietic stem cells. Risk factors
include advanced age, therapeutic radiation, receipt of supportive care,
smoking, and exposure to chemicals. It is the most common form of
myeloid leukemia among adults.
■ Chronic: Uncontrolled mutation of myeloid cells. This disease is rare in
children, and risk increases with age. The incidence of this type of leukemia
is increased with radiation exposure.
Lymphocytic Leukemia
■ Acute: Large numbers of bone marrow stem cells develop into lympho-
cytes. Most prevalent in children 3–7 yr old (most common childhood acute
leukemia).
■ Chronic: Only leukemia not related to radiation or chemicals. B lympho-
cytes do not go through apoptosis → excessive cells in bone marrow and
blood → enlarged nodes → hepatomegaly and splenomegaly → anemia
and thrombocytopenia. This type of leukemia has a slight genetic
predisposition.
Clinical Presentation
Acute Myeloid Leukemia
■ Fatigue
■ Shortness of breath
■ Bruising or bleeding
■ Petechiae rash
■ Weight loss or anorexia
■ Fever
■ Infection
■ Pain from enlargement of liver and spleen
■ Gum hyperplasia
■ Bone pain
Chronic Myeloid Leukemia
■ Many patients asymptomatic for long periods of time
■ Malaise
■ Loss of appetite
■ Weight loss
■ Spleen tenderness and enlargement
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