NCP Leukemias

The term leukemia describes a malignant disorder of the blood and lymph-forming tissues of the body. The blood’s cellular components originate primarily in the marrow of bones such as the sternum, iliac crest, and cranium. All blood cells begin as immature cells (blasts or stem cells) that differentiate and mature into RBCs, platelets, and various types of WBCs. In leukemia, many immature or ineffective WBCs crowd out the developing normal cells. As the normal cells are replaced by leukemic cells, anemia, neutropenia, and thrombocytopenia occur. Leukemia is acute when WBCs proliferate so rapidly that they lose the ability to regulate cell division and do not differentiate into mature cells.

In the chronic forms of leukemia, the disease develops gradually. The type of leukemia is based on the predominant cell line that is affected. In adults, the most common of the acute leukemias is acute myelocytic leukemia, which affects any type of WBC other than lymphocytes. The most common of the chronic leukemias is chronic lymphocytic leukemia, which is characterized by an abnormal increase in lymphocytes.


Acute inpatient care on medical unit for initial evaluation and treatment typically 4–6 wk, then at the community level.



Psychosocial aspects of care

Transplantation: postoperative and lifelong needs

Patient Assessment Database

Data depend on degree/duration of the disease and other organ involvement.


May report: Fatigue, malaise, weakness; inability to engage in usual activities, flu-like symptoms

May exhibit: Muscle wasting

Increased need for sleep, somnolence


May report: Palpitations

May exhibit: Tachycardia, heart murmurs

Pallor of skin, mucous membranes

Cranial nerve deficits and/or signs of cerebral hemorrhage


May report: Feelings of helplessness/hopelessness

May exhibit: Depression, withdrawal, anxiety, fear, anger, irritability

Mood changes, confusion


May report: Diarrhea; perianal tenderness, pain

Bright red blood on tissue paper, tarry stools

Blood in urine, decreased urine output

May exhibit: Perianal abscess; hematuria


May report: Loss of appetite, anorexia, vomiting

Change in taste/taste distortions

Weight loss

Pharyngitis, dysphagia

May exhibit: Abdominal distension, decreased bowel sounds

Splenomegaly, hepatomegaly; jaundice

Stomatitis, oral ulcerations

Gum hypertrophy (gum infiltration may be indicative of acute monocytic leukemia)


May report: Lack of coordination/decreased coordination

Mood changes, confusion, disorientation, lack of concentration

Dizziness; numbness, tingling, paresthesias

May exhibit: Muscle irritability, seizure activity, uncoordinated movements


May report: Abdominal pain, headaches, bone/joint pain; sternal tenderness, muscle cramping

May exhibit: Guarding/distraction behaviors, restlessness; self-focus


May report: Shortness of breath with minimal exertion

May exhibit: Dyspnea, tachypnea


Crackles, rhonchi

Decreased breath sounds


May report: History of recent/recurrent infections; falls

Visual disturbances/impairment

Nosebleeds or other hemorrhages, spontaneous uncontrollable bleeding with minimal trauma

May exhibit: Fever, infections

Bruises, purpura, retinal hemorrhages, gum bleeding, or epistaxis

Enlarged lymph nodes, spleen, or liver (due to tissue invasion)

Papilledema and exophthalmos

Leukemic infiltrates in the dermis


May report: Changes in libido

Changes in menstrual flow, menorrhagia



May report: History of exposure to chemicals, e.g., benzene (commercially used toxic liquid that is also present in lead-free gasoline), excessive levels of ionizing radiation; previous treatment with chemotherapy, especially alkalating agents

Chromosomal disorder, e.g., Down syndrome or Fanconi’s aplastic anemia

Exposure to virus, e.g., human T-cell leukemia/lymphoma virus-I (HTLV-I)

Discharge plan

DRG projected mean length of inpatient stay: 7.4–9.3 days

May need assistance with therapy and treatment needs/supplies, shopping, food

preparation, self-care activities, homemaker/maintenance tasks, transportation

Refer to section at end of plan for postdischarge considerations.


Carcinoembryonic antigen (CEA): May be elevated.

Cold agglutinins: May be elevated (more than 1:16) in lymphatic leukemia.

Cryoglobulins: Positive cryoglobulin findings may be present in patients with lymphocytic leukemia.

CBC: Indicates a normocytic, normochromic anemia.

Hemoglobin: May be less than 10 g/100 mL.

Reticulocytes: Count is usually low.

Platelet count: May be very low (less than 50,000/mm).

WBC: May be more than 50,000/cm with increased immature WBCs (“shift to left”). Leukemic blast cells may be present.

Prothrombin time (PT)/activated partial thromboplastin time (aPTT): Prolonged.

LDH: May be elevated.

Serum/urine uric acid: May be elevated.

Serum muramidase (a lysozyme): Elevated in acute monocytic and myelomonocytic leukemias.

Serum copper: Elevated.

Serum zinc: Decreased.

Bence Jones protein (urine): Increased.

Bone marrow biopsy: Abnormal WBCs usually make up 50% or more of the WBCs in the bone marrow. Often 60%– 90% of the cells are blast cells, with erythroid precursors, mature cells, and megakaryocytes reduced.

Chest x-ray and lymph node biopsies: May indicate degree of involvement.


1. Prevent infection during acute phases of disease/treatment.
2. Maintain circulating blood volume.
3. Alleviate pain.
4. Promote optimal physical functioning.
5. Provide psychological support.
6. Provide information about disease process/prognosis and treatment needs.


1. Complications prevented/minimized.
2. Pain relieved/controlled.
3. ADLs met by self or with assistance.
4. Dealing with disease realistically.
5. Disease process/prognosis and therapeutic regimen understood.
6. Plan in place to meet needs after discharge.

Refer to CP: Cancer, for further discussion/expansion of interventions related to cancer care and for patient teaching.