Leukaemia.
Neutropenic regime: (for all patients with a WCC< 1.0x 109/l) close liaison with a microbiologist is essential. Barrier nursing. Look for infection (mouth, perineum, axilla, and IVI site). Do swabs. Avoid IM injections (the danger is an infected haematoma). Do swabs. Avoid IM injections (the danger is an infected haematoma). Wash perineum after defecation. Swab moist skin with chlorhexidine. Avoid unnecessary PR examinations. Give hydrogen peroxide mouthwashes and candida prophylaxis. TPR every 4h. High calorie diet.
If Temperature >38 degC. for >4-6h or the patient is toxic start blind broad spectrum antibiotics. If there are chest signs consider treatment for Pneumocystis.
Prevent hyperkalaemia and hyperuricaemia following massive destruction of cells by giving a high fluid intake and allopurinol before cytotoxic therapy.
If the WCC is raised WBC thrombi may form in the brain, lung and heart (leucostasis). Transfusing here before the WCC is reduced increases the blood viscosity, so increasing risk of leucostasis.
DIC: this pathological activation of coagulation mechanisms may occur in any malignancy. The release of procoagulant agents leads to clotting factors and platelet consumption (consumption coagulopathy). Fibrin strands fill small vessels, slicing passing RBC.
Signs: extensive bruising, old venepuncture sites start bleeding, renal failure, gangrene, bleeding anywhere.
ALL:
This is a neoplastic proliferation of lymphoblasts.
Causes: unknown- but preconception paternal exposure to sawdust, benzene and radiation has been implicated.
Clinical Features: these are due to marrow failure: anaemia, infection and bleeding. Also: bone pain, arthritis, splenomegaly, lymphadenopathy, thymic enlargement, CNS involvement - cranial nerve palsy.
Common infections: CMV, candida, pneumocystosis, zoster, measles, bacterial septicaemia.
Treatment: supportive care: blood and platelet transfusion, IV antibiotics.
Preventing infections: Neutropenic regime, barrier nursing, prophylactic antibiotics.
Chemotherapy: remission induction: vincristine, prednisolone
CNS prophylaxis and maintenance chemotherapy;
Marrow transplant: consider in poor prognosis groups.
Quality of life: wigs for alopecia
Prognosis: cure rates high in children, low in adults.