Acute Lymphoblastic Leukemia- At a glance

1. Presented By:
Varsha M Varghese
M.Sc Nursing 1st Year

7. Normal Blood Cell Count:
1) Red blood cell (RBC) count
a) Men: 4.5 to 6 million red cells per microliter of blood
b) Women: 4 to 5 million red cells per microliter of blood
2) Hematocrit (the part of the blood made up of red
cells)
a) Men: 42% to 50%
b) Women: 36% to 45%
3) Hemoglobin (amount of the red-cell pigment that
carries oxygen)
a) Men: 14 to 17 grams per 100 milliliters of blood
b) Women: 12 to 15 grams per 100 milliliters of blood

8. 1 month 1 year 3 year 5 year 9 year 16 year
Haemog
lobin
(g/L)
102-130 104-132 107-136 110-139 113-143 115-165
(F)
130-180
(M)
1 month 1 year 3 year 5 year 9 year 16 year
Platelets
(x 109/L)
270-645 205-553 214-483 205-457 187-415 150-450
1 month 1 year 3 year 5 year 9 year 16 year
White cells
(x 109/L)
6.4-12.1 5.4-13.6 4.9-12.8 4.7-12.3 4.7-12.2 3.5-11

13. Neck lymph node
Lymph vessels
Underarm lymph nodes
Spleen
Diaphragm
Liver
Groin lymph nodes
LYMPH NODES

16.  Acute myeloid leukemia (AML)
 Acute lymphoblastic leukemia (ALL)
 Chronic myeloid leukemia (CML)
 Chronic lymphocytic leukemia (CLL)

17.  Acute lymphoblastic leukemia (ALL) is a type of cancer that
affects immature lymphocytes developing in the bone
marrow
 Under normal conditions these cells grow and mature into
specialized white cells called B-lymphocytes (B-cells) and
T-lymphocytes (T-cells)

18. 1) MORPHOLOGY
CYTOLOGIC
FEATURES
L1
(80-85%)
L2
(15%)
L3
(1-2%)
Cell size Small cells predominate
Homogenous
Large
Heterogeneous
Large
Homogenous
Amount of cytoplasm Scanty Variable
Often moderately
abundant
Moderately
Abundant
Nucleoli Small One or more
Often large
One or more
Prominent
Nuclear chromatin Homogenous Variable
Heterogeneous
Stippled
Homogenous
Nuclear shape Regular
Occasional clefts
Irregular clefts
Indentation
Regular
Oval to round
Cytoplasmic basophlia Variable Variable Intensely basophilic
Variable Variable Prominent

19. 2) IMMUNOPHENOTYPE
 Pre-B-cell ALL
 Early pre-B-cell
 Pre-B/transitional pre-Bcell ALL
[depending on antigens expressed on the leukemic cell surfaces]
 B-cell ALL
 T-cell ALL

20. 3) CYTOGENETICS
Technological advancement enable demonstration of abnormalities in the chromosomal
number and or structure in most of the cases of ALL

21. The medical term for Is
Low red blood cell count Anemia
Low platelet count Thrombocytopenia (“thrombocyte” is
another word for platelet)
Low neutrophil count Neutropenia (a neutrophil is a type of
white blood cell)

22. Causes Of ALL
 Ionizing radiation
 Chemicals
 Infections
 Electro-magnetic radiation
 Genetic factors

24.  Anaemia
 Increased bleeding or
bruising
 Frequent or repeated
infections
 Bone pain

25. Full blood count
Bone marrow examination
Lumbar Puncture

26.  Immunophenotyping
 Cytogenetic and molecular genetic tests
 Chromosome changes
 Molecular genetic tests

30.  Cortico-steroid therapy
 Central nervous system (CNS) treatment and prophylaxis
 Testicular radiotherapy

31. • Induction
• Consolidation
• Maintenance

33. Stem cell transplant

34. SIDE EFFECTS OF THE TREATMENT
Hyperpyrexia (with or without a rigor)
Bleeding or bruising
Prolonged nausea or vomiting
Diarrhoea, stomach cramps or severe constipation
Persistent coughing or shortness of breath
Rash, reddening of the skin, itching
Headache
A new severe pain or persistent unexplained soreness
A cut or other injury
Persistent pain, swelling, redness or pus anywhere on their
body, especially near their central line site

35. Effects on the bone marrow
 White cells: neutropenic
 Platelets: can bruise and bleed more easily
 Red cells: anaemic
 Hair loss
 Mucositis
 Diarrhoea
 Constipation
 Nausea and vomiting
 Loss of appetite
 Fatigue
 Seizures

36. SIDE EFFECTS OF CORTICO-STEROIDS
Fluid retention
Weight gain
The classic ‘moon-shaped’ face
Swollen belly
Binge eating (night and day).
Insomnia
Mood swings
Anxiety
Restlessness and nightmares
Increased susceptibility to infections
High blood pressure
Osteoporosis
Avascular necrosis

37.  Obesity
 Reproductive difficulties
 Delayed growth
 Learning difficulties

38.  Risk For Infection
 Risk for Deficient Fluid Volume
 Acute Pain
 Activity Intolerance
 Deficient Knowledge

39. Comparing doctors' and nurses' accounts of how they provide
emotional care for parents of children with
acutelymphoblastic leukaemia
Forsey M1, Salmon P, Eden T, Young B
Abstract
OBJECTIVE:
Despite the emphasis that communication skills training (CST) programmes place on
attending to the emotional care of patients, evidence suggests that practitioners
neglect this aspect of patient care. We describe and compare doctors' and nurses'
accounts of managing the emotional care of parents of children with leukaemia, with
the overall objective of examining how their accounts might inform training and policy.

40. METHODS:
Audio-recorded qualitative interviews with 30 doctors and nurses working in six UK
paediatric oncology and haematology treatment centres were analysed
interpretatively, drawing on the constant comparative method
RESULTS:
Doctors' and nurses' descriptions of managing emotional care differed markedly.
Doctors described reassuring parents through their ongoing clinical care of the child
and by explaining the potentially curative nature of treatment. Doctors did not think
they could reassure parents by eliciting and explicitly discussing parents' fears. In
contrast, nurses relied on psychological skills and explicit discussion of parents'
emotions to provide reassurance. Both doctors and nurses relied on each other to
ensure that parents' emotional needs were met by the multidisciplinary team rather
than by individual practitioners