I. Pathophysiology: malignant disorder of the blood and bone
marrow characterized by the uncontrolled accumulation of
white blood cells (WBCs)
a. Blood cells originate primarily in the marrow of bones,
such as the sternum, iliac crest, and cranium, and begin as
immature cells (blasts or stem cells) that differentiate and
mature into red blood cells (RBCs), platelets, and various
types of WBCs.
b. Production of normal blood cells markedly decreased,
leading to anemia, thrombocytopenia, neutropenia
c. Rapid growth of immature or ineffective WBCs and delayed
cell death lead to their accumulation in bone marrow, blood,
spleen, and liver.
a. Dependent on the type of cell involved—myelogenous or
lymphocytic—as well as duration: acute (acute myelogenous
leukemia [AML], acute lymphocytic leukemia [ALL]);
or chronic (chronic myelogenous leukemia [CML], chronic
lymphocytic leukemia [CLL])
1. WBCs proliferate so rapidly that they lose the ability
to regulate cell division and do not differentiate into
2. Most common form in adults is AML, which affects
different types of WBCs, with the exception of
3. Progresses rapidly without treatment
1. Chronic forms have few or no blast cells.
2. Most common form is CLL, which is characterized by
abnormal increase in lymphocytes.
3. Develops gradually and progresses more slowly than
a. Exact cause is unknown.
b. Risk factors (Seiter, 2006)
i. Antecedent histological disorders: diseases of the bone
marrow, such as myelodysplastic syndrome (MDS)
ii. Environmental exposures: radiation, smoking, benzene
iii. Prior chemotherapy
iv. Genetics or congenital disorders: develop more often in
a. Morbidity: In 2007, an estimated 44,240 new cases of
leukemia (all types) were diagnosed in the United States;
diagnosed more often in males than females; chronic
leukemias account for 7% more cases than acute; most
cases occur in older adults, with more than half occurring
after age 67 (The Leukemia & Lymphoma Society’s SEER
Facts 2007–2008); with AML, the median age of onset is
65 years (Seiter, 2006).
b. Mortality: In 2005, an estimated 9,000 deaths from AML
in the United States were reported (Seiter, 2006); majority
of those with CLL live 5 to 10 years; however, presence
of complications may shorten survival to 2 to 3 years
(Perry & Rasool, 2005).
c. Cost: Projected cost for care was $2.6 billion in 2004
(National Cancer Institute [NCI], 2007).
Client receives acute inpatient care on medical or oncology
unit for initial evaluation and treatment, typically for 4 to
6 weeks, and then at the community level.
Psychosocial aspects of care,
Transplantation considerations—postoperative and lifelong,
1. Prevent infection during acute phases of disease and
2. Maintain circulating blood volume.
3. Alleviate pain.
4. Promote optimal physical functioning.
5. Provide psychological support.
6. Provide information about disease process, prognosis,
and treatment needs.
1. Complications prevented or minimized.
2. Pain relieved or controlled.
3. Activities of daily living (ADLs) met by self or with
4. Dealing with disease realistically.
5. Disease process, prognosis, and therapeutic regimen
6. Plan in place to meet needs after discharge.