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LEUKEMIA DAN THALASEMIA

DWI NOVITASARI, S.Kep., Ns., M.Sc


Development of
blood cells from the
bone marrow
Division of stem cell into blood cells
Acute leukemia
• Acute leukemia is one form of leukemia.
• Leukemia refers to a group of malignant
disorders
• characterized by abnormal proliferation and
maturation of lymphocytes and
nonlymphocytic cells,
• leading to the suppression of normal cells
Type of Acute leukemia

• acute lymphocytic leukemia (ALL)

• acute myeloid leukemia (AML; also known as


acute nonlymphocytic leukemia or acute
myeloblastic leukemia)
1. Acute Lymphocytic Leukemia (ALL)

• 80% of childhood leukemias.


• Treatment leads to remission in 81% of
children, who survive an average of 5 years,
• in 65% of adults, who survive an average of 2
years.
• Children between ages 2 and 8 who receive
intensive therapy have the best survival rate
2. Acute Myeloid Leukemia (AML)

• is one of the most common leukemias in


adults.
• Average survival time is only 1 year after
diagnosis even with aggressive treatment.
• Remissions lasting 2 to 10 months occur in
50% of children
Cause
• The exact cause of acute leukemia isn’t known
• 40% to 50% of patients have mutations in
their chromosomes.
• Individuals with certain chromosomal
disorders have a higher risk.
• Down syndrome, trisomy 13, and other
heredity disorders have a higher incidence of
leukemia.
risk factors
• certain viruses, such as human T-cell
lymphotrophic virus
• cigarette smoking
• exposure to certain chemicals (such as
benzene, which is present in cigarette smoke
and gasoline)
• exposure to large doses of ionizing radiation
or drugs that depress the bone marrow
Pathophysiology
• Immature hematopoietic cells undergo an
abnormal transformation, giving rise to
leukemic cells.
• Leukemic cells multiply and accumulate,
crowding out other types of cells.
• Crowding prevents production of normal red
blood cells and white blood cells (WBCs) and
platelets, leading to pancytopenia
Pathophysiology

• Pancytopenia is reduction in the number of all


cellular elements of the blood.
Clinical Findings
• Infection related to myelosuppression from
treatment, direct invasion of the bone
marrow, development of fistulas, or
immunosuppression from hormonal release in
response to chronic stress
Clinical Findings
• Bleeding due to thrombocytopenia from
bone marrow suppression. Even when the
platelet count is normal, platelet function may
be impaired in hematologic cancers.
• Anemia due to cancer of the blood forming
cells, WBCs, or RBCs
Clinical Findings
• Malaise and lethargy related to anemia, as
there are fewer functional cells to maintain
metabolism
• Fever and night sweats resulting from bone
marrow invasion and cellular proliferation
within bone marrow
Clinical Findings

• pain due to infiltration of bone marrow


• paleness and weakness due to anemia
• weight loss due to generalized wasting of fat
and protein, and decreased appetite
Diagnostic acute leukemia
Treatment acute leukemia

• Systemic chemotherapy to eradicate leukemic


cells and induce remission
• Antibiotic, antifungal, and antiviral drugs
• Colony-stimulating factors such as filgrastim
(Neupogen) to spur the growth of granulocytes,
RBCs, and platelets
• Transfusions of platelets to prevent bleeding and
RBCs to prevent anemia
Chronic leukemia

• is the most benign and slowest progress


inform of leukemia.
• This type of chronic leukemia occurs most
commonly in elderly people, and more than
one half of the cases are male
Chronic leukemia

• The prognosis is poor if anemia,


thrombocytopenia, neutropenia, bulky
lymphadenopathy, or severe lymphocytosis
develops.
• is the most common cause of death, usually 4
to 5 years after diagnosis.
Cause

• Unknown
• Hereditary factors suspected
Pathophysiology

• is a generalized, progressive disease.


• It causes a proliferation and accumulation of
relatively mature looking but immunologically
inefficient lymphocytes.
• After these cells infiltrate, clinical signs appear
Clinical Findings

• Fever resulting from bone marrow invasion


and cellular proliferation within bone marrow
• Bleeding tendencies secondary to
thrombocytopenia
• Frequent infections related to deficient
humoral immunity
Clinical Findings

• Fatigue related to anemia


• Enlargement of lymph nodes and
hepatomegaly from infiltration by leukemic
cells
• Splenomegaly secondary to increased
numbers of lysed red blood cells being filtered
Diagnostic chonic lymphocitic leukemia
Treatment
• Systemic chemotherapy, using the alkylating
drugs chlorambucil (Leukeran) or
cyclophosphamide (Cytoxan), with presence of
autoimmune hemolytic anemia or
thrombocytopenia

• Prednisone for refractory disease


Treatment

• Local radiation to reduce organ size and help


to relieve symptoms when obstruction or
organ impairment or enlargement occurs
• Radiation therapy for enlarged lymph nodes,
painful bony lesions, or massive splenomegaly
• Allopurinol (Zyloprim) to prevent
hyperuricemia
THALASSEMIA
Karakteristik Thalassemia
This illustration shows how white blood cells (agranulocytes
and granulocytes) proliferate in the bloodstream in leukemia,
overwhelming red blood cells (RBCs) and platelets.
Sign and symptoms
Sign and symptoms