Acute Myeloid Leukemia

Presently, AML is the most common adult-onset leukaemia. In 100,000 people, only 3.6% of it may have AML. Its incidence increases with age especially for those who reached 65 years old and above. In the past 10 years, there is a significant evidence of increase in number of cases of AML.

Causative Factors:

  1. Heredity – People who have a family history of chromosal abnormalities such as Down syndrome and other blood related diseases such as Fancomi anemia have a higher probability of developing AML.
  2. Radiation – Exposure in radiation may also predispose an individual. It was found out that individuals who survived the Hiroshima bombing develop AML after 5 to 7 years. The usage of alkylating agents may also increase the chances of having AML. Therapeutic radiation such as X-ray imaging has lesser probability of causing AML.
  3. Chemical products – Chemical products used in making plastic products such as the compound Benzene may also increase the development of AML. Petroleum products as well as embalming fluids can also increase the chances of individuals to develop such illness.

Classification:

According to the World Health Organization, the basis for classifying AML depends on myeloblasts. The presence of greater than or equal to 20% myeloblasts in blood or bone marrow may mean that the individual is positive of AML.

Here is the classification:

I. AML with recurrent genetic abnormalities especially presence of abnormal bone marrow eosinophils.

II. AML with multilineage dysplasia

III. AML and myelodysplastic syndrome which is alkylating-agent

French-American- British Classification:

MO: Minimally differentiated leukaemia

M1: Myeloblastic leukaemia without maturation

M2: Myeloblastic leukaemia with maturation

M3: Hypergranular promyelocytic leukaemia

M4: Myelomonocytic Leukemia

M4 EO: Variant increase in abnormal marrow eosinophils

M5: Monocytic Leukemia

M6: Erythroleukemia

M7: Megakaryoblastic Leukemia

Clinical Presentation:

Signs and Symptoms:

  1. Nonspecific symptoms
  2. Anemia
  3. Leukocytosis
  4. Leucopoenia
  5. Leukocyte dysfunction
  6. Thrombocytopenia
  7. Fever
  8. Splenomegaly
  9. Hepatomegaly
  10. Lymphadenopathy
  11. Sternal Tenderness
  12. Infection and haemorrhage

A medical history may reveal that the individual may complain increasing fatigue. There are bleeding tendencies also reported or thrombocytopenia. There are unexplained fever episodes also that are accompanied by headache. Patients may also loss their appetite since there is spenomegaly.

Nursing Management:

  1. Assess for the response in activities of daily living. Easy fatigability is the first symptom to appear among cases.
  2. Watch out for fever as well as changes in the vital signs such as tachycardia.
  3. Ask the patient for visual changes such as papilledema, retinal infiltrations, and cranial nerve abnormalities.
  4. Check for the appetite, as well as the dental health. There are cases that patients suffer in poor dentition as well as gum hypertrophy.
  5. Changes in skin as well as nodules
  6. Conduct a physical assessment in order to find evidence for splenomegaly, hepatomegaly and lymphadenopathy.
  7. Assist the patient for screening examinations such as MRI for complaints in back pain, lower extremity weakness or paresthesias.

Medical Treatment:

According to the National Cancer Institute the course of treatment of AML may include two phases. The first phase involves the remission induction therapy wherein the leukaemia cells are eradicated in the blood as well as in the bone marrow. This process gets rid of defective leukocytes that may worsen the stage of AML.

The second phase involves killing the remaining cells that may have regrown. The phase is called post-remission therapy since there are cases that relapse may happen. There is continuous monitoring on the presence of leukaemia cells.

 

Imgae by: http://akiavintage.com

Byron Webb Romero, RN, MSN

Finished BSN at Lyceum of the Philippines University, and Master of Science in Nursing Major in Adult Health Nursing at the University of the East Ramon Magsaysay Memorial Medical Center. Currently working at Manila Doctors College of Nursing as a Team Leader for Level I and II, Lecturer for Professional Nursing Subjects, and also a Clinical Instructor.

What Do You Think?