Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia
Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia Arifin Dwi Atmaja, S. Kep. Doc. Arifin Dwi Atmaja, S. Kep.
Introduction Leukemia: 25 -35% Childhood Cancer ALL: Malignant Disease l Progressive Infiltration of Bone Marrow and Lymphatic Organs by immature lymphoid cell lymphoblasts l Doc. Arifin Dwi Atmaja, S. Kep.
Etiology and Epidemiology Radiation Chemicals Drugs Viruses Genetic Abnormalities Doc. Arifin Dwi Atmaja, S. Kep.
Incidence 3 per 100. 000 children l Peak: 2 -6 years Sardjito (1992 -1998) Leukemia= 48% Indonesia problems: l Registration, Protocol, Specific diagnosis, Cost (drugs and suportive) Doc. Arifin Dwi Atmaja, S. Kep.
Prognosis Poorer Countries: prognosis poor Many patients without any treatment Doc. Arifin Dwi Atmaja, S. Kep.
Clinical Signs Symptoms: l l Malaise, Fatigue Bleeding, bruising Fever Bone pain Lymphadenophaty (80% Splenomegali and hepatomegali (70 -75%) Enlargement of the testes CNS: Intracranial pressure > and cranial nerve palsies) Doc. Arifin Dwi Atmaja, S. Kep.
Laboratory and Radiology Peripheral blood: anemia, trombocytopenia, Neutropenia Bone marrow Aspirate: >25% leukemia lymphoblasts Radiographic: Mediastinal mass (5 -10%) Doc. Arifin Dwi Atmaja, S. Kep.
FAB Classification Morphological classification: French-American-British (FAB): L 1: 80%, L 3: < 2%, L 2: the Remainder L 1: Higher remission Prolonged survival than L 2 and L 3: The worst prognosis Doc. Arifin Dwi Atmaja, S. Kep.
Prognostic Factors WBC, Hb, Trombosit Age Cytogenetic Age Organomegaly FAB Morphology Immunophenotype Mediastinum mass, Sex, CNS disease Doc. Arifin Dwi Atmaja, S. Kep.
ALL Management in childhood Four components Remission induction l Intensification l CNS treatment l Continuation l The purpose: eradicate leukemic cells Doc. Arifin Dwi Atmaja, S. Kep.
Remission induction Regimen: Vincrisrine (VCR) l Dexzamethasone l Methotrexate (MTX) intratekal l Daunorobicin (Dauno) hanya untuk resti l L-asparaginase l Doc. Arifin Dwi Atmaja, S. Kep.
Problems: Difficult diagnosis l Education/ information l No cost, no delay l Complications/ failure l Doc. Arifin Dwi Atmaja, S. Kep.
Intensification/ consolidation Combination: l MTx iv, 6 - MP and L-asp Problems: cost, complications, isolation room Doc. Arifin Dwi Atmaja, S. Kep.
Supportive care Hemorrhage Infection Leukemia patient’s association Doc. Arifin Dwi Atmaja, S. Kep.
Terima kasih Doc. Arifin Dwi Atmaja, S. Kep.
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