A generalized, progressive disease that’s common in elderly people, chronic lymphocytic leukemia is marked by an uncontrollable spread of abnormal, small lymphocytes in lymphoid tissue, blood, and bone marrow. The prognosis is poor if anemia, thrombocytopenia, neutropenia, bulky lymphadeno-pathy, or severe lymphocytosis is present.
Nearly all patients with chronic lymphocytic leukemia are men older than age 50. According to the American Cancer Society, chronic lymphocytic leukemia accounts for almost one-third of new leukemia cases annually.
Although the cause of chronic lymphocytic leukemia is unknown, researchers suspect hereditary factors (higher incidence has been recorded within families), still-undefined chromosome abnormalities, and certain immunologic defects (such as ataxia-telangiectasia or acquired agammaglobulinemia). The disease doesn’t seem to be associated with radiation exposure.
Chronic lymphocytic leukemia is the most benign and the most slowly progressive form of leukemia. Signs and symptoms derive from the infiltration of leukemic cells in bone marrow, lymphoid tissue, and organ systems.
In early stages, patients usually complain of fatigue, malaise, fever, and nodal enlargement. They’re particularly susceptible to infection, which may be fatal.
In advanced stages, patients may experience severe fatigue and weight loss, with liver or spleen enlargement, bone tenderness, and edema from lymph node obstruction. Pulmonary infiltrates may appear when lung parenchyma is involved. Skin infiltrations, manifested by macular to nodular eruptions, occur in about one-half of the cases of chronic lymphocytic leukemia.
As the disease progresses, bone marrow involvement may lead to anemia, pallor, weakness, dyspnea, tachycardia, palpitations, bleeding, or infection. Opportunistic fungal, viral, and bacterial infections commonly occur in late stages and result in fatal septicemia.
Typically, chronic lymphocytic leukemia is an incidental finding during a routine blood test that reveals numerous abnormal lymphocytes. In early stages, the white blood cell (WBC) count is mildly but persistently elevated. Granulocytopenia is the rule, but the WBC count climbs as the disease progresses.
Blood studies also show a hemoglobin level below 11 g, hypogammaglobulinemia, and depressed serum globulin levels. Other common findings include neutropenia (less than 1,500/µl), lymphocytosis (more than 10,000/µl), and thrombocytopenia (less than 150,000/µl). Bone marrow aspiration and biopsy show lymphocytic invasion.
Systemic chemotherapy includes an alkylating drug, usually chlorambucil or cyclophosphamide, and sometimes a steroid (prednisone) when autoimmune hemolytic anemia or thrombocytopenia occurs.
When chronic lymphocytic leukemia causes obstruction or organ impairment or enlargement, local radiation treatment can be used to reduce organ size. Allopurinol can be given to prevent hyperuricemia, a relatively uncommon finding.
❑ Focus patient care on relieving symptoms and preventing infection. Clean the patient’s skin daily with mild soap and water. Frequent soaks may be ordered. Monitor the patient for signs and symptoms of infection: temperature over 100° F (37.8° C), chills, redness, or swelling of any body part.
❑ Watch for signs and symptoms of thrombocytopenia (easy bruising, nosebleeds, bleeding gums, and black, tarry stools) and anemia (pale skin, weakness, fatigue, dizziness, and palpitations).
❑ Advise the patient to avoid aspirin and products containing aspirin. Explain that many medications contain aspirin. Teach him how to recognize aspirin variants on medication labels.
❑ Explain chemotherapy and its possible adverse effects.
CLINICAL TIP: If the patient will be discharged, tell him to avoid coming in contact with obviously ill people, especially children with common contagious childhood diseases.
❑ Urge the patient to eat high-protein foods and drink high-calorie beverages.
❑ Stress the importance of follow-up care, frequent blood tests, and taking all medications exactly as prescribed.
❑ Teach the patient the signs and symptoms of recurrence (swollen lymph nodes in the neck, axillae, and groin; increased abdominal size or discomfort), and tell him to notify his physician immediately if he detects any of them.
❑ Provide emotional support for the patient.
❑ Explore alternative health measures that may benefit the patient.
❑ Provide supportive nursing care in terminal stages by managing pain, fever, and bleeding.
❑ Spiritual care or other support services may assist in meeting patient and family needs.
❑ If the patient is to return to home, provide appropriate referrals such as home or hospice care.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5 
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