Awareness of leukemia

First, the preamble
Leukemia is a blood or blood-forming organs of the malignant disease, accounting for one third of children with malignant tumors, in recent years as a result of chemical treatment and other supportive therapy (such as antibiotics, blood transfusion, analgesic antiemetic therapy, etc.) have made considerable progress, more than 95% patients can get complete remission. The progress of medicine allows doctors to make the correct diagnosis in after effective treatment and to maintain an appropriate quality of life. In this small list will introduce you to what is meant by leukemia, diagnosis, examination, treatment and care, so parents can participate, so that child leukemia can be more and better care and take care of.

Second, what is leukemia? What is leukemia?

Also known as leukemia leukemia generally refers to an abnormal white blood cell hyperplasia. The occurrence of leukemia in children, including acute lymphoblastic leukemia (ALL), acute myelogenous leukemia (AML or ANLL), chronic myeloid leukemia (CML).

ALL of which about seven, eight, and about the Second AML into many, CML rare. Cause has yet to understand. Sometimes as early symptoms of flu, loss of appetite, fatigue, and often persistent fever. Because of anemia caused by pale, and bleeding tendency, and lead to petechiae who appear, the body often infected, often aching bones and so on, through the blood and bone marrow examination and other methods found in the abnormal white blood cells, are necessary to the process of diagnosis of leukemia and conditions.

Taiwan each year about more than 200 children under the age of 15 be leukemia, such as the treatment will not lead to death. Such as receive a complete treatment七成about more than ALL can be cured; ANLL Although the cure rate is low, but if in the first bone marrow remission after can have an appropriate bone marrow transplant, then the cure rate can improve five,60% around.

Throughout the complete treatment plan will take about two to three years time, just started the first treatment aimed at the restoration of bone marrow hematopoietic function, known as the access to mitigation. Mitigation does not mean cured, still have to receive continuous treatment, arbitrary treatment of its own to stop will lead to relapse and serious consequences.

Third, the symptoms of leukemia

Early symptoms may be anorexia, easy fatigue, fever or hemorrhagic petechiae often phenomenon.

※ lymph nodes, but most do not feel pain or tenderness, usually occurs in the neck, armpit or groin.

※ weight loss, loss of appetite, the child gradually wasting.

※ fever: because of the proliferation of abnormal white blood cells, release caused by hot substance, or normal leukopenia, infection part of the company.

※ anemia: red blood cells because reduced hemoglobin reduced.

※ bone or joint pain.

※ skin ecchymosis or bleeding point, because it was thrombocytopenia.

※ color greenish yellow, fever or sweating.

※ prone to such as: nosebleeds, oral bleeding, occasionally there will be a black stool or urine.

※ swollen testicle and kidney.

※ hepatosplenomegaly.

※ tonsils, mouth, trachea were lymphocytes violations affect the respiratory and swelling.

Fourth, the diagnosis of leukemia

Leukemia diagnosis, initially by medical history, blood test (CBC) and blood smears. If the examination results suspicious, you must make bone marrow examination to confirm leukemia.

Symptoms of leukemia in the beginning, may be associated with symptoms similar to flu, fever, fatigue, pale and so on; and leukemia bud cells (cells) in the pathogenesis of the early days will not necessarily appear in the peripheral blood, but in the bone marrow already exists a certain number of leukemia bud cells (cancer), so bone marrow examination is necessary, its purpose is to ascertain the diagnosis of leukemia and its cell type to classify, judge determine the diagnosis of lymphatic leukemia or myelogenous leukemia . Cell type classification is very important, because different types of leukemia have different treatment plans.

◎ bone marrow examination:

Is a simple security check, about 10 minutes time-consuming to complete, the general adult prothorax are from the sternum, and many children from the back hip (waist) near the ridge after the site of iliac bone to obtain marrow. Sampling process is first of all, one small area of narcotic subcutaneous skin and under the periosteum, and then insert the needle bone marrow examination of bone marrow cavity, re-use syringes to draw organization out to do a small amount of bone marrow examination.

◎ spinal fluid examination:

Its purpose has two, one for mining cytology samples to do not only check whether the spinal cord cells have buds, if it exists, compared with bud cells have a violation of the central nervous system. The second purpose for the appropriate amount of chemical drugs was injected into the central nervous system (this treatment is called intrathecal chemotherapy), as methods to prevent central nervous system leukemia and central nervous system to kill cells within the bud. Examination and treatment of this often in a few minutes to complete. The process is to insert a needle between two lumbar vertebrae, so that is stored in the spinal cord around the spinal cord drops out a few cc, and then injected into the same volume of chemical medicines West. Examination and treatment, the need to lie flat or one hour or more to complete.

Inspection of the above-mentioned diagnosis of leukemia is a necessary process, regardless of blood, bone marrow and spinal fluid of the inspection report, for the assessment of disease prognosis have a very important influence. As the physician in accordance with the risk of relapse of patients to determine the extent of treatment program (treatment), throughout the course of these inspections, is also a very useful assessment tool, in addition to providing physicians adjust treatment program indicators, and early detection of patients whether there is any recurrence of the disease situation.

Five, how to treat

(1) Chemical treatment: Chemical treatment of leukemia giving the goal in making the disease have been alleviated, and then continue through the regular use of drugs to kill the remaining cancer cells, thus the purpose of recovery. At present, treatment principles, first of all, in accordance with the condition, according to the child's prognosis and disease severity, the district is divided into groups ranging from the severity of light treatment were relatively light, and those courses must be re-aggravated.

Chemical therapy treatment can be divided into:

1. Guide remission: patients with onset of the first four, five weeks, are for the guidance period, and guide the restoration of normal bone marrow function, which is the so-called "mitigation." This period the remaining blood cells are around one per cent of the original.

2. The consolidation of treatment period: This period is the replacement of drugs, the eradication of residual cancer cells, so that the number of remaining blood cells to achieve the ideal of less than one ten thousandth.

3. Maintenance therapy period: a day to give medication.

4. To strengthen the treatment period: given a regular basis to enhance treatment.

5. Central nervous system preventive treatment: chemotherapy because the general can not arrive the central nervous system, so it is necessary to have intrathecal injection. Nevertheless, anti-cancer

Drugs can follow spinal fluid circulation to protect the meninges, and the elimination of hidden in the central nervous system cancer cells.

Chemical treatment of different types of leukemia have different approaches to treatment. Physicians in establishing the diagnosis, we will tell patients that will use a method of treatment, and to introduce the principle of treatment of content and treatment.

(B), supportive therapy:

As a result of the disease itself and the effects of chemical drugs, the body will produce a variety of symptoms and questions, the most important of which are caused by too few platelets bleeding, and too few white blood cells caused by bacteria, fungus or virus infection.

◎ infusion treatment of anemia can be red blood cells, the treatment of bleeding may be platelet transfusion; too few white blood cells cause fever and infection can be treated with antibiotics; their patients, including supply enough nutrition, and prevention of infection.

(C) radiation therapy:

For the prevention of cancer metastasis to the central nervous system, chemical treatment, depending on the child's physician will decide whether to accept the Department of cranial radiation therapy, such as violations of the central nervous system has leukemia, is usually required to undergo cranial radiation treatment.

(D), bone marrow transplantation:

Bone marrow transplantation for a number of ineffective chemotherapy, relapse, or belonging to high-risk group of acute lymphocytic leukemia patients, no doubt, is to provide another glimmer of hope. For children with acute myelogenous leukemia in early remission, if appropriate, bone marrow transplant can provide a better cure rate of; of chronic myeloid leukemia, bone marrow transplantation can be cured by the opportunity.

6. All kinds of chemical drugs may cause side effects

Drug Name
Route of administration
Side effects

Asparaginase
(Leunase)
Intramuscular injection of nausea, vomiting, fever, urticaria, liver, pancreatic dysfunction, pancreatitis, hyperglycemia, reduced fibrinogen, blood vessel embolism and personality change.
Muscular or intravenous Bleomycin pneumonia-like pulmonary fibrosis, fever, Scleroderma disease-like lesions, stomatitis, vein wall thickening.
Cisplatin intravenous drip injection of nausea, vomiting, loss of appetite, severe renal toxicity, tinnitus or hearing loss, bone marrow inhibition.
Cyclophposphamide
(Endoxan)
Oral, intravenous injection or drip nausea, vomiting, loss of appetite, hemorrhagic cystitis, bone marrow inhibition, oral mucosa ulcers, secondary formation of Neoplasia, baldness, skin blackened fingernails.
Cytarabine
(Cyclocide, Ara-C)
Muscular, intravenous drip or injection, Intrathecal injection of nausea, vomiting, loss of appetite, inhibition of bone marrow, oral mucosa ulcers, diarrhea, thrombotic phlebitis, fever, skin rash.
Intravenous Epirubicin nausea, vomiting, mucosal ulcers, cardiac toxicity, fever, skin ulcers caused by inadvertent leakage necrosis.
Doxorubicin
(Adriamycin)
Intravenous injection of nausea, vomiting, mucosal ulcers, cardiac toxicity, inadvertent leakage caused necrotic skin ulcers.
Etoposide (Vp-16) intravenous drip injection of nausea, vomiting, bronchus, liver, kidney toxicity high, breathing, bone marrow inhibition.
Fluorouracil
(5-FU)
Oral, intravenous injection or drip nausea, vomiting, bone marrow inhibition, stomatitis, watery diarrhea, hair loss, skin diseases.
Ifosfamide
(Holoxan)
Intravenous injection or drip nausea, vomiting, bone marrow inhibition, alopecia, hemorrhagic cystitis.
Vincristin
(Oncovin)
Intravenous injection of constipation, hair loss, neurological toxicity, abdominal pain, urinary retention, inhibition of bone marrow function, nausea, vomiting.
Methotrexate
(MTX)
Oral, muscular, intravenous drip or injection, the spinal cord injection of nausea, vomiting, bone marrow inhibition, oral ulcers, liver toxicity, alopecia, urticaria, headache, insomnia.
Mitoxantron
(Novantron)
Intravenous drip injection of nausea, vomiting, bone marrow inhibition, hair loss, poor appetite, allergies, diarrhea, pain, tired tired, fever, mucositis.
Mercaptopurine
(6-MP)
Oral nausea, vomiting, bone marrow suppression function, jaundice, excessive uric acid.
Thioguanine
(6-TG)
Oral bone marrow inhibition, excess uric acid, liver toxicity.
Prednisolone
Dexan
Oral obesity, moon face, hypertension, peptic ulcer.
Navoban (antiemetic) oral administration, intravenous injection or drip headache, head or upper have flushing or hot feeling, constipation.
Zofran (antiemetic) oral administration, intravenous injection or drip headache, gastrointestinal discomfort.

Seven complications

Complications of leukemia, the main and chemical drugs and their role in cell lysis or the disease itself, including leukemia combined tumor lysis syndrome, bone marrow infection and loss of function resulting in bleeding and neurological toxicity.

(1) leukemia combined tumor lysis syndrome

(B) suppression of bone marrow function

1. Platelet deficiency is too low.

2. Anemia.

3. Neutrophil disorders is too low and has a fever.

4. Severe infection led to bacteremia, shock.

Eight, nursing care for the guidance of

In the face of cancer and the pain process, the child in addition to chemotherapy, a more careful look after the needs of parents and thus provide the following nursing care for common sense, to help the child's parents from the actual observation, in order to understand child's physical condition, and further to give the child proper care.

(1) regular medication, be allowed to stop:

1. When the child was discharged, it will bring home to return home with oral medication, parents should be aware of drugs and side effects of taking methods. (Oral chemical drugs: the prevention of infection or drug or other drugs)

2. Do not stop the drugs, caused disease relapse again.

(B) the prevention of infection:

1. To maintain the home in good hygiene habits, especially the kitchen, toilet cleaning maintenance.

2. To prevent access to public places, something children need when they go out wearing masks outside.

3. To avoid a cold, contact with patients with infectious diseases.

4. To avoid long exposure to chicken pox patients. Such as found in the home environment has a long chicken pox, the patient required close to its isolation, and return to hospital for further examination. Once chickenpox infection patients need treatment immediately, or else lead to complications, the mortality rate very high.

(C) to develop good hygiene habits:

1. The use of soft toothbrush, to develop a habit of brushing their teeth after eating to reduce the oral retention of food residues and reduce bacterial growth.

2. Daily bathing, and to observe the physical integrity of the skin, with or without wounds,破皮, bleeding points, bruise, and abnormal circumstances出疹子.

3. To develop a fixed bowel habits, stool after by going to wipe the anus.

4. To avoid the volume of rectal temperature and the use of anal suppository to prevent damage to the anal mucosa inflammation.

5. To keep the perineum clean, easy to hide foreskin boys dirt, to be cleaned.

(D) the prevention of hemorrhage:

1. Air-conditioning to maintain an appropriate degree of humidity, the nasal cavity to avoid over-drying, non-hands to prevent epistaxis.

2. Children Games to avoid fall injuries, pay attention to home safety and to avoid higher ground climbing, so as not to fall.

3. Periodic trimming nails, so as not to scratch the skin.

4. The skin if a blood clot, not stripped, so that a blood clot on its own loss.

5. To wear appropriate clothing (avoid tight clothes, and select the appropriate shoes).

6. Do not walk barefoot on the floor.

(E) to observe the signs of bleeding:

1. Mucocutaneous small bleeding points, or bruise.

2. Stool a red or black (tar color).

3. Urine red.

4. Vomits red or brown.

5. Platelets is low, there will be headache, vomiting, drowsiness and other phenomena, if the unconscious brain hemorrhage may need urgent hospital treatment.

(F) deal with bleeding

1. Gingival site of bleeding, direct pressure with cotton in the affected area until the blood only.

2. Epistaxis, the down side of nose bleeding, called the child sitting at the same time, ice on his forehead and body to lean forward, do not ingestion nose so as to avoid choking. If more than sustained bleeding that required hospital treatment.

(Vii) treatment of fever

1. Axillary temperature 37.5 ℃ to 37 ℃ between, drink plenty of water, fruit juice and reduce by covered.

2. Axillary temperature 37.5 ℃ to 38 ℃ between the use of ice pillows.

3. Axillary temperature above 38 ℃, the use of antipyretics.

4. If the ball less than 1000 particles, axillary temperature above 37 ℃ more than three times a day, or axillary temperature above 38 ℃ more than once a day, then back to hospital treatment.

(Viii) the principles of nutrition

1. General diet can be.

2. To avoid to eat lettuce, raw.

3. To avoid eating food stimulus (such as pepper, coffee, etc.).

4. The options can be peeled or peel fruit.

5. Attention to hygiene when cooking.

(IX). Gastrointestinal side

1. Completed chemotherapy to return home, if persistent nausea, unable to eat, the need to return to hospital to seek to prevent water and electrolyte imbalance.

2. Diarrhea when mining light diet and avoid eating food aerogenes.

3. Observation of diarrhea at the time of stool frequency, shape, color, nature, if the diarrhea does not improve the situation, to be returned to hospital treatment.

4. Constipation when eating vegetables and fruits, as well as adequate intake of fluid. If it fails to solve the stool more than three days, doctors may be instructed to use soft drugs, to avoid their own use of enema.

(J) taboo

1. To avoid the use of aspirin's anti-fever drugs (such as: pain wink), and anti-fever agent Cypriot.

2. Chemical treatment, prevention to avoid vaccination.

(Xi) the use of mother Manual

Prepare a notebook to record each patient's blood leukocytes, hemoglobin, platelet and granulocyte changes, as well as the home when the abnormal situation.

Can help parents understand the child's parents understand the child's blood flow conditions, if in the bone marrow inhibition period, children with weak resistance, should be pre -

Anti-infection, and pay attention to the child's physiological changes.

(Xii) medical procedures

1. Patient: by the discharge or last outpatient appointment at the time, regular inspections.

2. Emergency: If a high fever, bleeding, convulsion, dizziness, headache, severe nausea, diarrhea, hemorrhage, chicken pox, etc., the need to receive emergency medical treatment immediately.