Ⅰ、What is a leukemia

Health education Number:HEMA-107. Leukemia. Set date:2012.07.31 Revised date:2018.08.15 Review date:2014.05.15. Ⅰ. What is leukemia? Leukemia, also called blood cancer, is results from excessive proliferation of the immature white blood cell in the blood or the bone marrow.. Ⅱ、Pathogenesis and classification 1.The possible pathogenesis of leukemia include: (1) Radiation: long-term exposure to radiation or history of radiation therapy. (2) Chemical agent: long-term exposure to organic dye or paint or history of specific chemotherapy. (3) Heredity or gene mutation: inherited from family with congenital chromosome abnormality or somatic mutation without obvious cause. (4) Defects in the auto-immune system or history of viral infection.. To deliver intelligent and holistic medicine and to provide the best healthcare Compassion Quality Innovation Accountability All information above has been reviewed by Hematology specialists Edited and published by the Department of Nursing, Taichung Veterans General Hospital 1.

2. There are 4 major types of leukemia : (1) Acute lymphoid leukemia (ALL): frequently occurs in children below 10 years old; approximately 20% patients are adults. (2) Acute myeloid leukemia (AML): frequently occurs in adults, account for 80% of adult leukemia cases. (3) Chronic lymphoid leukemia (CLL): frequently occurs in adults above 50 years old. (4) Chronic myeloid leukemia (CML): frequently occurs in patients around 40-60 years old.. III、Symptoms of leukemia 1. Persistent fever without obvious reason. 2. Hemorrhage: bleeding from the nose or the gum; petechiae or ecchymosis on the skin, abnormal massive bleeding during menstruation, etc. 3. Anemia: pale looking and fatigue, dyspnea on exertion 4. Bone pain 5. Others: gum swelling, enlargement of the lymph nodes, hepatosplenomegaly, body weight loss or abdominal fullness, etc.. IⅤ、Diagnosis 1. Blood routine: Leukocytosis (super-high white blood cell count reach several hundred thousands) or sometimes leukopenia (low white blood cell count); Anemia; Thrombocytopenia (low platelet count) 2.

2. The smear of peripheral blood: many abnormal blast cells (immature white blood cells) 3. Bone marrow biopsy and aspiration: The puncture site is usually at posterior iliac crest, sometimes at sternum. A special needle is used to puncture into the medulla for a piece of bone for pathology and aspirate 8-10 cc of marrow blood for examination. 4. Chromosomal test：Sampling while procedure of bone marrow biopsy, which can help for diagnosis or follow-up of leukemia and multiple myeloma. 5. Molecular testing：Sampling while procedure of bone marrow biopsy, which can help for leukemia prognosis prediction. 6. Other imaging studies：Including abdominal sonography or CT、 MRI, to detect the hepatosplenomegaly.. V. Treatment The treatment is based on different types of leukemia: 1. Chemotherapy: As the most important treatment, it can be roughly divided into two stages. The first stage is “ induction therapy ”. The purpose is to kill blood cancer cells so as to achieve complete remission, and let the bone marrow grow normal white blood cells, platelets and red blood cells. After that, it is necessary to accept the second phase of "consolidation therapy" in order to remove residual cancer cells. In order to improve long-term survival, some patients, such as lymphoid and acute myeloid leukemia, require two to three years of "maintenance therapy." 2. Radiation therapy: can be divided into local or systemic radiation 3.

therapy. To prevent the flow of a small number of cancer cells to the central nervous system, physicians may recommend preventive treatment for the central (brain, spinal cord), and systemic radiation therapy for bone marrow transplantation. 3.Allogeneic hematopoietic stem cell transplantation: (1) Sources derived from stem cells can be divided into bone marrow stem cells, peripheral blood stem cells, and cord blood stem cells. Allogeneic Bone Marrow Stem Cell Transplantation: After receiving high-dose chemotherapy and systemic radiation therapy, the cancer cells and the originally abnormal bone marrow are eliminated, then the donor's bone marrow is input, and the normal bone marrow cells are transfused to the patient like a blood transfusion to replace the abnormal bone marrow. It enables normal bone marrow function to rebuild the patient's hematopoietic system and immune system.. (2) Allogeneic Peripheral Blood Stem Cell Transplantation: Since donors do not need to undergo general anesthesia to obtain stem cells in the hospital, they are exempted from the risk of pain and anesthesia due to extraction, are less likely to be contaminated than bone marrow transplants, and can reduce infections, deaths, and length of hospital stay. Is a more commonly adopted method of transplantation. (3) Umbilical cord blood stem cell transplantation: It is collected by the mother's placenta and stored. Because of the small amount of stem cells, it is only suitable for transplantation in children. It is one of the most popular treatment methods in recent years. 4.

4. Immunotherapy: Interferon. 5. Target treatment: In addition to chronic myelogenous leukemia, it can be used as an "adjuvant treatment" for chemotherapy.. VI、Side effects of treatment Cells that are more rapidly dividing, such as hematopoietic cells, hair root cells, and digestive tract mucosa cells, are easily destroyed by chemotherapy or the like. Common side effects are reduced patient resistance, easy fatigue; easy to bruise or difficult to stop bleeding, hair loss, nausea, vomiting and oral ulcers. 1.Leukocyte, thrombocytopenia: It should prevent infection, avoid strenuous exercise, and pay attention to the safety of activities to prevent injury and bleeding. 2. Hair loss: It is short-lived, and you can prepare wigs, scarves, hats, etc. for proper dressing. 3. Feel sick and vomit: Appropriate use of antiemetics according to the doctor's instructions, diet should be light, eat a small number of meals. 4. Oral ulcers: Use mouthwash to keep your mouth clean and prevent stomatitis.. Conclusion Leukemia is not an incurable disease now due to modern medical advancement. Patient should face the disease with positive attitude and receive treatment after well discussion with doctors.. 5.