Nursing Guide to Leukemia: Nursing Diagnosis, Interventions, & Care Plans

Leukemia is a type of cancer that affects the blood and bone marrow, characterized by the abnormal proliferation of white blood cells (WBCs). These abnormal cells interfere with the body's ability to fight infections, produce healthy blood cells, and maintain proper immune function.  

Leukemia is broadly classified into four main types: acute lymphocytic leukemia (ALL), acute myeloid leukemia (AML), chronic lymphocytic leukemia (CLL), and chronic myeloid leukemia (CML). Leukemia can be acute, which progresses rapidly, or chronic, which progresses more slowly. 

Etiology and epidemiology 

The exact cause of leukemia is not fully understood, but several risk factors are associated with its development, including genetic predisposition, environmental exposures (such as radiation or certain chemicals), and previous chemotherapy or radiation treatments. Chromosomal abnormalities, such as the Philadelphia chromosome in CML, also play a role in certain types of leukemia. 

• Acute lymphocytic leukemia (ALL) is most common in children, accounting for about 75% of pediatric leukemia cases.
• Acute myeloid leukemia (AML) is the most common form of leukemia in adults, though it can also affect children.
• Chronic lymphocytic leukemia (CLL) primarily affects older adults and is often diagnosed incidentally.
• Chronic myeloid leukemia (CML) is linked to a specific genetic mutation and typically affects adults. 

Globally, leukemia accounts for about 3% of all cancers. In 2020, there were an estimated 474,519 new cases of leukemia worldwide. 

Leukemia ICD-10 codes 

• C91.0: Acute lymphoblastic leukemia
• C92.0: Acute myeloid leukemia
• C91.1: Chronic lymphocytic leukemia
• C92.1: Chronic myeloid leukemia 

Source: ICD10data.com (https://www.icd10data.com/ICD10CM/Codes/C00-D49/C81-C96/C91-) 

Diagnosis 

Leukemia is often suspected based on a combination of clinical presentation and laboratory findings, and confirmed through diagnostic tests: 

• Complete blood count (CBC): Leukemia often leads to abnormal WBC counts (either high or low), anemia, and thrombocytopenia (low platelet count).
• Peripheral blood smear: This test allows for visualization of abnormal WBCs.
• Bone marrow biopsy: A definitive diagnosis of leukemia is made through a bone marrow biopsy, which identifies the presence of malignant cells in the bone marrow.
• Cytogenetic analysis: Identifies specific chromosomal abnormalities, such as the Philadelphia chromosome in CML.
• Flow cytometry: Used to determine the type of leukemia by analyzing the proteins on the surface of the cancerous cells.
• Lumbar puncture: Performed in cases where there is concern for central nervous system involvement, especially in ALL. 

Management 

Treatment for leukemia depends on the type, stage, and patient factors such as age and overall health. Main treatment modalities include: 

• Chemotherapy: The cornerstone treatment for most types of leukemia, chemotherapy targets rapidly dividing cancer cells.
• Induction therapy: The first phase, aimed at achieving remission.
• Consolidation/intensification therapy: Used to eliminate residual disease.
• Maintenance therapy: Long-term, low-dose chemotherapy used in some cases (e.g., ALL).
• Targeted therapy: In CML and some forms of ALL, tyrosine kinase inhibitors (e.g., imatinib) target the specific mutations driving leukemia growth.
• Immunotherapy: CAR-T cell therapy and monoclonal antibodies (e.g., rituximab) are newer options, particularly for ALL and CLL.
• Stem cell transplantation (SCT): In high-risk or relapsed cases, a stem cell transplant may be recommended to replace the patient’s bone marrow with healthy stem cells.
• Radiation therapy: Occasionally used, especially in cases of CNS involvement or to shrink a large mass.
• Supportive care: Transfusions of red blood cells and platelets, antibiotics, and growth factors (e.g., granulocyte colony-stimulating factor) are critical in managing complications like anemia, infection, and thrombocytopenia. 

Leukemia nursing care plan 

Nursing considerations 

Leukemia patients often experience fatigue, infection risk, bleeding, and emotional distress. Nurses must focus on managing these symptoms and providing education and support throughout the treatment process. 

Assessment 

• Monitor CBC and differential: Watch for signs of increased risk for infection (neutropenia), anemia, and thrombocytopenia. 
• Evaluate for signs of infection: Fever, chills, and any new symptoms should be reported immediately, as leukemia patients are immunocompromised. 
• Assess bleeding: Look for petechiae, bruising, and bleeding gums, particularly in thrombocytopenic patients. 
• Psychosocial assessment: Determine the patient’s coping mechanisms, support system, and need for psychological support. 

Nursing diagnosis/risk for 

• Risk for infection related to leukopenia and immunosuppressive treatments 
• Risk for bleeding related to thrombocytopenia and bone marrow suppression 
• Fatigue related to anemia and the effects of chemotherapy 
• Disturbed body image related to hair loss, weight loss, and pallor from leukemia treatment 

Interventions 

• Infection prevention: Implement neutropenic precautions, such as hand hygiene, limiting visitors, and avoiding exposure to infectious agents. 
• Bleeding precautions: Educate the patient on avoiding activities that may lead to injury, using soft toothbrushes, and avoiding over-the-counter medications like aspirin. 
• Supportive care: Provide energy-conserving strategies for managing fatigue, such as frequent rest periods and small, nutrient-dense meals. 
• Emotional support: Offer counseling services and encourage participation in leukemia support groups. Assist patients with coping strategies and body image issues, including hair loss management. 

Expected outcomes 

• Patient will remain free of infection and bleeding complications 
• Fatigue will be managed effectively with appropriate interventions 
• Patient will demonstrate understanding of leukemia and its treatment, including potential side effects 
• Patient will develop coping strategies to manage the emotional and physical challenges of leukemia 

Individual/caregiver education 

• Educate the patient and family about the importance of infection prevention and how to recognize signs of infection, such as fever. 
• Discuss potential side effects of chemotherapy and targeted therapies, including nausea, hair loss, and increased risk of bleeding. 
• Provide information about stem cell transplantation, if applicable, including the process and potential complications. 
• Encourage caregivers to provide emotional support and help manage the patient’s day-to-day needs, including transportation to treatments and ensuring medication adherence. 

References 

1. Leukemia & Lymphoma Society: https://www.lls.org/ 
2. National Cancer Institute: https://www.cancer.gov/ 
3. American Cancer Society: https://www.cancer.org/ 

Leukemia - StatPearls - NCBI Bookshelf (nih.gov) 

Resources 

• Leukemia & Lymphoma Society: Provides comprehensive information, support, and financial assistance for leukemia patients. Website: https://www.lls.org/ 
• American Cancer Society: Offers resources on leukemia and support for patients and families. Website: https://www.cancer.org/ 
• National Cancer Institute: Provides detailed information about leukemia, clinical trials, and treatment options. Website: https://www.cancer.gov/