Acute Lymphoblastic Leukemia

After this lesson you will be able to: - Explain how lymphoblasts crowding the bone marrow produce the anemia, bleeding, infection and organ infiltration seen in acute lymphoblastic leukemia (ALL). - Interpret the results that define ALL and its risk group: blood count, marrow blasts, immunophenotype, cerebrospinal fluid (CSF) status and minimal residual disease. - Describe the treatment phases (induction, consolidation or intensification, maintenance and central nervous system (CNS)-directed therapy) and the nursing safety points for asparaginase, vincristine and intrathecal chemotherapy. - Recognize the ALL emergencies: febrile neutropenia, tumour lysis syndrome, hyperleukocytosis with leukostasis, a mediastinal mass compressing the airway, superior vena cava or heart, and asparaginase anaphylaxis, pancreatitis, thrombosis and hepatic veno-occlusive disease. For each, state the first RN action, who is notified and how fast. - Teach the child, family or adult patient the fever plan and the warning signs that need an immediate call.