|
Case
Summary
1.
Acute lymphocytic leukemia is the most common type of leukemia
found in children. ALL accounts for about two thirds
of all cases. In ALL there is a proliferation of lymphoblasts,
causing a decrease in other cell types.
2.
Noah's symptoms at the time of his return visit to his
pediatrician were not alarming. He was very tired; his
mother assumed this was due to a recent Strep infection. He
did have some bleeding and bone pain. Symptoms in ALL come
on abruptly and include fatigue (caused by anemia), bleeding
(resulting from thrombocytopenia), and fever due to infection.
Bone pain is often present due to the infiltration of leukemic
cells. If the cerebral or spinal meninges have been infiltrated,
the patient may exhibit neurological symptoms including headache,
vomiting, and blurred vision.
3.
Acute leukemias are diagnosed on clinical and laboratory
findings. Noah's pediatrician made the initial diagnoses based on
the peripheral blood smear which showed the presence of blasts.
The pathologist confirmed the diagnosis from a bone marrow
examination which showed a hypercellular bone marrow with greater
than 30% blasts. Cytochemical stains and immunologic marker
studies are performed to differentiate the different leukemias.
4.
Treatment consists of chemotherapy and supportive therapy such as
blood transfusions and antibiotics. In ALL, intratheical
chemotherapy, spinal radiation, or a combination of both are
usually needed.
Bone marrow transplants
are now being used successfully, usually in patients who have a
recurrence of the leukemia.
5.
The five year survival rate for children diagnosed with leukemia
and subsequently treated is approximately 70%. The response
to treatment varies greatly for each individual. Recovery
rates are constantly improving with continuing research of new
and better methods to treat leukemia.
6.
Although the cause of leukemia is not known, certain risk factors
have been identified which increase the chance of developing
leukemia. Risk factors include exposure to high-energy
radiation, electromagnetic fields, and certain chemicals such as
benzene. Avoidance of these environmental risk factors may
aid in prevention. Other risk factors may be genetic and/or
viral in nature and at this point cannot be prevented.
7.
Many health professionals work together to treat a child with
leukemia. In this case, the pediatrician made the initial
diagnosis and then referred the child to a pediatric oncologist
who specializes in the treatment of childhood diseases of the
blood. Nurses are the main link between the health care
team and the family. They care for the child during
hospital stays performing a multitude of duties including
checking vital signs, starting I.V.'s, giving medications, and
making sure the child is comfortable. Patient's often
receive chemotherapy in the oncologist's office. Nurses
work with the oncologist to deliver chemotherapy and educate
cancer patients about their disease. Clinical laboratory
scientists perform laboratory testing which aids in the diagnosis
and continual assessment of the child's condition. The
pathologist obtains and analyzes bone marrow samples. The
secondary complication of pneumonia was treated by respiratory
therapists who assessed breathing capacity and administered
oxygen. The radiological technicians obtained chest x-rays,
which allowed the radiologist to diagnose the life-threatening
pneumonia. All of the health care team worked together in
diagnosing and treating this child.
|
