Module 6 Acute Lymphocytic Leukemia

What is ALL?

Cancer of the stem cells in the bone marrow that produce lymphocytes.

Registered nurse.

Care for child, check vitals, start I.Vs, give meds, and make child comfortable.

Agranular WBC's.

Lymphocyte and monocyte.

Granular WBC's.

Neutrophil, Eosinophil, and Basophil.

Thrombocytes.

Platelets.

Oncologist.

Treats the cancer.

Percentage of basophils.

0.5-1%

Percentage of eosinophils.

2-4%

Percentage of lymphocytes.

20-25%

Percentage of monocytes.

3-8%

Percentage of neutrophils.

60-70%

ALL is the most common cancer in young children. What is the approximate cure rate in children?

80%.

What is a bone marrow procedure?

A bone marrow procedure (commonly referred to as a bone marrow or bone marrow aspiration) is a technique used to obtain the blood-forming portion (marrow) of the inner core of bone for examination in the laboratory or for transplantation. The bone marrow consists of inserting a special needle into a bone that contains marrow and withdrawing the marrow by suction or coring out a sample of the marrow.

What is a chest x-ray?

A chest x-ray is a radiology test that involves exposing the chest briefly to radiation to produce an image of the chest and the internal organs of the chest.

Anemia.

A decrease in the number of red blood cells or hemoglobin in the blood. This leads to a decrease in the amount of oxygen getting to the cells. Symptoms include fatigue and pallor.

Thrombocytopenia.

A decrease in the number of thrombocytes (platelets) in the blood which may lead to bleeding, bruising, and decreased clotting time.

Why did Noah develop a fever?

A fever is a symptom of a possible infection.

What is a spinal tap or a lumbar puncture?

A lumbar puncture (an LP) is the insertion of a needle into the fluid within the spinal canal. It is termed a "lumbar puncture" because the needle goes into the lumbar portion (the "small") of the back.

Which health care professionals worked together to diagnose and treat Noah's pneumonia? Define each role.

A nurse or respiratory therapist collected a sputum sample for culture. A medical laboratory scientist performed the gram stain and culture on the sample and issued a report. A radiology technician performed a chest x-ray. A radiologist read the x-ray and issued a report. The physician ordered antibiotics to treat pneumonia based on the x-ray and culture reports. Respiratory therapists administered and monitored oxygen monitored blood gas levels and administered chest physiotherapy.

What abnormality in Noah's bone marrow smear was suggestive of a Leukemia?

A preponderance of one cell line, blasts.

Two groups of bacteria differentiated by a gram stain.

A staining procedure used to differentiate bacteria into two classifications, gram positive and gram negative. Positive has thicker cell walls than negative gram stains.

Pus.

A thick whitish-yellow fluid which results from the accumulation of white blood cells (WBCs), liquefied tissue and cellular debris. Pus is commonly a site of infection or foreign material in the body.

What abnormalities can be detected from a chest x-ray?

Abnormalities of the lungs including pneumonia, bronchitis, asthma, cysts, and cancers. Abnormalities of the heart including fluid around the heart, enlarged heart, heart failure, abnormal anatomy. Broken chest bones.

What are the four most common types of leukemia? In which age groups is each most predominantly found?

Acute lymphocytic leukemia (ALL) is the most common type of leukemia in young children. This disease alsoaffects adults, especially those age 65 and older. Acute myeloid leukemia (AML) occurs in both adults and children. Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55. It sometimes occurs in younger adults, but it almost never affects children. Chronic myeloid leukemia (CML) occurs mainly in adults. A very small number of children also develop this disease.

Basophils high in count.

Allergic reactions, leukemias, cancers, hypothyroidism.

Eosinophils high in count.

Allergic reactions, parasitic infections, autoimmune diseases.

Why would an immunocompromised patient be more susceptible to disease?

An immunocompromised patient has a depressed immune system and is unable to mount a response to disease.

Pneumonia.

An infection that occurs when fluid and cells collect in the lungs. Pneumonia can be caused by bacteria, viruses, and other pathogenic organisms. It can also be caused by chemicals or other irritants.

What is pneumonia? What are some causes of pneumonia?

An infection that occurs when fluid and cells collect in the lungs. Pneumonia can be caused by bacteria, viruses, and other pathogenic organisms. It can also be caused by chemicals or other irritants.

Lymphocytes.

B cells will divide into plasma cells which make antibodies. T cells can directly attack a cell infected with a virus of cancer.

Neutrophil high in count.

Bacterial infection, burns, stress, and inflammation.

What does the word "acute" mean when talking about ALL?

Cancer cells multiply rapidly crowding out normal cells in blood and bone marrow.

How is bone marrow transplanted?

Blood stem cells (immature cells that can grow into red blood cells, white blood cells, and platelets) are transfused into the bloodstream.

Transportation.

Blood transports oxygen from the lungs to the tissues, and then picks up carbon dioxide and wastes the tissue for elimination from the body.

Monocytes low in count.

Bone marrow suppression, treatment with cortisol.

What tests help a physician diagnose leukemia?

CBC, bone marrow smear.

What is chemotherapy? How is it given? What are some of the side effects of chemotherapy?

Chemotherapy is treatment with drugs to kill cancer cells. Drugs are generally administered through an I.V. (intravenously) and given in cycles. Side effects differ depending upon the drugs used and the patient. Side effects may include fatigue, bleeding or bruising, loss of appetite, nausea, and vomiting, hair loss, or mouth sores.

CBC

Common test that is done to find out if. person is anemic, has an infection, or if you have a tendency to bleed.

Why is a lumbar puncture performed?

Diagnostic purposes: obtain a sample of spinal fluid for examination. Therapeutic purposes: administer antibiotics, cancer drugs or anesthetic agents.

Do Noah's CBC and bone marrow aspirate results indicate he is making progress? Base your answer on specific results.

Different cell lines are represented in the CBC and Bone Marrow smear instead of just one abnormal one. This indicates that progress is being made.

Eosinophils low in count.

Drug toxicity, stress, acute allergic reactions.

What abnormalities were present in the laboratory tests?

Elevated WBC count, decreased RBC, Hct, and platelet count. A decrease in normal White Blood Cells; elevated abnormal White Blood Cells (blasts).

Eosinophils.

Elevated when someone has allergies or inflammation. They also attack parasitic worms.

What are common symptoms of leukemia?

Fever, chills, and other flu-like symptoms; Weakness and fatigue; Frequent infections; Loss of appetite and/or weight; Swollen or tender lymph nodes, liver, or spleen; Easy bleeding or bruising; Tiny red spots (called petechiae) under the skin; Swollen or bleeding gums; Sweating, especially at night; and/or Bone or joint pain

Upper lobe infiltrate.

Filling of air spaces with fluid, inflammatory exudates, or cells that fill the lungs.

Components of blood.

Formed elements that consist of cells and cell fragments. They can further be divided by RBC's and WBC's. Platelets are cell fragments that break off from a large cell in the bone marrow, a megakaryocyte. 55% is plasma, 45% RBC's, and a Buffy coat that is WBC's and platelets.

Pluripotent stem cells.

Generated directly from somatic cells.

Why is the gram stain an important first step in the identification of a pathogen.

Gram positive organisms are often treated with different antibiotics than gram negative organisms. Its important to a physician because empiric antibiotic therapy may be started based upon the gram stain.

A gram stain differentiates bacteria into what two classes?

Gram-positive and gram-negative bacteria.

Differentiate between granular and agranular.

Granular cells have chemical granules that give them that look and agranular cells don't have granules.

What are possible sources for transplanted cells?

Healthy individuals can donate marrow from the iliac crest (hip bone). Healthy individuals can donate blood stem cells. The patient can use stem cells from their own blood if they're healthy enough to donate. (From the website) Umbilical cord blood may also be used.

Blasts.

Immature blood cells found in bone marrow.

What is the difference between chronic and acute leukemia? How do the symptoms differ?

In acute leukemia, the abnormal blood cells are blasts that remain very immature and cannot carry out their normal functions. The number of blasts increases rapidly, and the disease gets worse quickly. In chronic leukemia, some blast cells are present, but in general, these cells are more mature and can carry out some of their normal functions. Also, the number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually. In acute leukemia, symptoms appear and get worse quickly. People with this disease go to their doctor because they feel sick. In chronic leukemia, symptoms may not appear for a long time; when symptoms do appear, they generally are mild at first and get worse gradually. Doctors often find chronic leukemia during a routine checkup--before there are any symptoms.

Lumbar puncture.

Insertion of a needle into the subarachnoid space between the third and fourth or fourth and fifth lumbar vertebrae to withdraw fluid for diagnosis. Diagnoses meningitis, neurologic diseases, or effects of systemic diseases of brain and spinal cord.

Define Leukemia.

Leukemia is a cancer of the blood. A large number of abnormal blood cells are produced which do not function properly.

Major component of the immune system.

Lymphocytes.

Pediatrician.

Made the initial diagnosis.

What health care professional is responsible for gram stain and culture testing?

Medical Laboratory Scientist (gram).

Which health professional is responsible for performing Noah's laboratory tests?

Medical Laboratory Scientist (lab).

Myeloid stem cells.

Monocytes, macrophages, neutrophils, basophils, eosinophils, erythrocytes, and megakaryocytes to platelets.

Bone marrow aspirate.

Needle aspirate of marrow from iliac crest or sternum. Diagnose things that affect the blood.

Phagocytes.

Neutrophils and macrophages.

What is the difference between Noah's initial and final chest x-ray?

Noah's initial chest x-ray showed infiltrates (a cloudy area) indicative of pneumonia. His final chest x-ray was clear indicating a clearing of the infection.

What evidence can be noted in the CBC and bone marrow results to indicate Noah is in remission?

Normal cell values and normal cell lines are present.

Radiology technician.

Obtained the x-ray.

Pathologist.

Obtains and analyzes bone marrow.

Which health professional would Noah's pediatrician be most likely to consult with?

Pediatric Oncologist.

Medical laboratory scientist.

Perform laboratory tests which aid in the diagnosis and continual assessment of childs conditions.

What are the 5 common symptoms of ALL that are talked about in this video?

Persistent fever, fatigue, bleeding, easy bruising, swollen lymph nodes.

Neutrophils.

Powerful phagocyte and can engulf foreign bacteria.

Basophils low in count.

Pregnancy, ovulation, stress, hypothyroidism.

Lymphocytes low in count.

Prolonged illness, HIV infection, immunosuppression, treatment with cortisol.

What chemicals or constituents can be measured from the cerebral spinal fluid?

Protein, glucose, cell count and pressure.

Formed elements of blood.

RBCs, WBCs, and platelets.

Neutrophil low in count.

Radiation exposure, drug toxicity, vitamin B12 deficiency, systemic lupus erythematosus.

What is radiation therapy?

Radiation in high doses is aimed at tumors or specific areas of the body containing the disease.

Chemotherapy is the first line of treatment for ALL. What treatments would follow if chemotherapy fails?

Radiation therapy, biologic therapy, a bone marrow transplant.

Blood-brain barrier.

Special characteristics of the capillary walls of the brain that prevent potentially harmful substances from moving out of the bloodstream into the brain or cerebrospinal fluid.

Radiologist.

Specializes in the use of x-rays.

Are Noah's symptoms consistent with Strep infection?

Symptoms are not consistent with a Strep infection.

What symptoms did Noah exhibit?

Symptoms include pallor, bone tenderness, enlarged spleen and lymph nodes, bruising, bleeding (nosebleeds).

Lymphoid stem cell.

T cells, B cells, and natural killer cells.

Throat culture.

Test used to identify pathogens, especially group A streptococci. Swab the back of the throat.

What is cerebral spinal fluid?

The CSF circulates around the brain and spinal cord (the central nervous system). This "water bath" acts as a support of buoyancy for the brain and spinal cord. The support of the CSF helps to protect the brain from injury.

Regulation.

The blood is key in maintaining homeostasis. Blood is also important in distributing heat in the body and regulating body temperature.

Protection.

The blood literally has an army of cells and proteins that help protect us from infection.

Remission.

The disappearance of the signs and symptoms of cancer or other diseases. When this happens, the disease is said to be "in remission." A remission can be temporary or permanent.

Why would the physician order a chest x-ray?

The physician suspects pneumonia, which can be detected on a chest x-ray.

What is bone marrow and what is its purpose?

The spongy tissue inside some of the bones. Its purpose is to make blood cells.

Meninges.

The three membranes that cover the brain and spinal cord. The membranes consist of the dura mater (external), arachnoid (middle), and pia mater (internal).

Monocytes.

They become macrophages, a powerful phagocyte.

Basophils.

They play a key role in the inflammatory response.

Hematopoiesis.

This is how blood cells are formed in the bone marrow.

Petechiae.

Tiny red spots in the skin which do not blanch when pressed upon. They result from red blood leaking from capillaries.

Function of blood that helps maintain acid/base homeostasis.

Transportation, protection, and regulation.

Respiratory therapist.

Treated secondary complication of pneumonia, assessed breathing capacity and gave oxygen.

Chest x-ray.

Used to detect abnormalities in the lungs, but can also detect abnormalities in the heart, aorta, and bones of the thoracic area.

Lymphocytes high in count.

Viral infections, some leukemias, infectious mononucleosis.

Monocytes high in count.

Viral or fungal infections, tuberculosis, some leukemias, other chronic diseases.

Constituents of blood plasma.

water, some solutes including proteins.