Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia by pptfiles

VIEWS: 1,044 PAGES: 15

									Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia
Arifin Dwi Atmaja, S. Kep.

Doc. Arifin Dwi Atmaja, S. Kep.

Introduction
Leukemia: 25-35% Childhood Cancer ALL:
Malignant Disease  Progressive Infiltration of Bone Marrow and Lymphatic Organs by immature lymphoid cell lymphoblasts


Doc. Arifin Dwi Atmaja, S. Kep.

Etiology and Epidemiology
Radiation Chemicals Drugs Viruses Genetic Abnormalities

Doc. Arifin Dwi Atmaja, S. Kep.

Incidence
3 per 100.000 children


Peak: 2-6 years

Sardjito (1992-1998) Leukemia= 48% Indonesia problems:


Registration, Protocol, Specific diagnosis, Cost (drugs and suportive)

Doc. Arifin Dwi Atmaja, S. Kep.

Prognosis
Poorer Countries: prognosis poor Many patients without any treatment

Doc. Arifin Dwi Atmaja, S. Kep.

Clinical Signs
Symptoms:
   

Malaise, Fatigue Bleeding, bruising Fever Bone pain

Lymphadenophaty (80% Splenomegali and hepatomegali (70-75%) Enlargement of the testes CNS: Intracranial pressure > and cranial nerve palsies)
Doc. Arifin Dwi Atmaja, S. Kep.

Laboratory and Radiology
Peripheral blood: anemia, trombocytopenia, Neutropenia Bone marrow Aspirate: >25% leukemia lymphoblasts Radiographic: Mediastinal mass (5-10%)

Doc. Arifin Dwi Atmaja, S. Kep.

FAB Classification
Morphological classification: French-American-British (FAB): L1: 80%, L3:< 2%, L2: the Remainder
L1: Higher remission
Prolonged survival than L2 and L3

L3: The worst prognosis
Doc. Arifin Dwi Atmaja, S. Kep.

Prognostic Factors
WBC, Hb, Trombosit Age Cytogenetic Age Organomegaly FAB Morphology Immunophenotype Mediastinum mass, Sex, CNS disease
Doc. Arifin Dwi Atmaja, S. Kep.

ALL Management in childhood
Four components
Remission induction  Intensification  CNS treatment  Continuation


The purpose: eradicate leukemic cells

Doc. Arifin Dwi Atmaja, S. Kep.

Remission induction
Regimen:
Vincrisrine (VCR)  Dexzamethasone  Methotrexate (MTX) intratekal  Daunorobicin (Dauno) hanya untuk resti  L-asparaginase


Doc. Arifin Dwi Atmaja, S. Kep.

Problems:
Difficult diagnosis  Education/ information  No cost, no delay  Complications/ failure


Doc. Arifin Dwi Atmaja, S. Kep.

Intensification/ consolidation
Combination:


MTx iv, 6- MP and L-asp

Problems: cost, complications, isolation room

Doc. Arifin Dwi Atmaja, S. Kep.

Supportive care
Hemorrhage Infection Leukemia patient’s association

Doc. Arifin Dwi Atmaja, S. Kep.

Terima kasih

Doc. Arifin Dwi Atmaja, S. Kep.


								
To top