Hematology: Leukemia Assessment and Manifestations

Leukemia, as discussed in previous lectures, is a condition that results to an overproduction of white blood cells. Due to this overproduction, there is a crowding out of the other types of blood cells inside the bone marrow.

In this instruction, we’ll be going through the clinical manifestations of leukemia and how to accurately assess a client who is suffering from the disease.

Pain

Due to the crowding out of the white blood cells, the pressure is being pushed on the bone; thus, bone pain occurs, making it a crucial clinical manifestation of leukemia.

Bone pains would feel like they are bursting at the joint. The client will also experience pancytopenia which is just a fancy word that means all kinds of cells are decreasing. Back pain is another essential manifestation of leukemia.

Hemoglobin and Hematocrit

The hemoglobin and hematocrit level will go down, causing an increased heart rate.  Hemoglobin is the transporter of oxygen throughout the body. Therefore, if there is low hemoglobin and hematocrit, the heart will compensate by pumping faster. Aside from that, the client will also show signs of fatigue and shortness of breath due to low oxygen capacity carriers.

Skin

Having low hemoglobin and hematocrit will cause decreased capillary refill time, which is evidenced by a pale skin. So, if a client comes in with an increased heart rate and pale skin, there is a probability that there is insufficient blood volume.

Decreased Appetite

Low blood volume will also affect the gastrointestinal tract, leading to decreased appetite which will then result in weight loss. The weight loss is so severe that a client sheds off around 20 pounds a week.  Take note of this vital information because this is an NCLEX^® test tip. Aside from weight loss, another gastrointestinal manifestation is vomiting coupled with nausea.

Headaches and Dizziness

Less blood flow means low oxygenation to the brain. Therefore, precipitating manifestations like dizziness and headaches will arise.

Bleeding

Blood workups like complete blood count will show a significant increase in WBC, whereas the hemoglobin and hematocrit are decreased as well as the platelets. As for the international normalized ratio (INR), prothrombin time (PT), and partial prothrombin time (PTT), they are bound to increase since there is not enough platelet to regulate normal clotting. Because of this, the client is bound to bleed in certain areas in the body.

Bleeding will be evident in the following:

• Urine
• Gastrointestinal tract
• Feces that is dark-tinged
• Hematomas on different parts of the body
• Gums
• Profuse bleeding from a simple cut

Informing the client about bleeding manifestations is important because it can abruptly cause death, especially during the acute phase of leukemia. Bleeding is the main nursing priority that should be addressed immediately.

Interventions

What are the different types of treatments given to leukemia clients?

1. Stem cell transplant or engraftment
2. Chemotherapy

Chemotherapy is crucial in refreshing the bone marrow to create blood cells from scratch. This procedure is a form of restart button to prompt the bone marrow to begin the process of creating normal red blood cells and white blood cells.

For the complete pathophysiology of leukemia, you can visit our Simple Nursing website and YouTube channel.