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.


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.


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.


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.


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.

Leukemia: Nursing Considerations and Management

In today’s leukemia lecture, we’ll be talking about the basic treatments and interventions that primarily influence your client’s condition. The information that will be given here is critical in passing major nursing exams, especially the NCLEX®.

So, let’s figure out what are the things that you should focus on, especially in managing clients with leukemia.

Uncomplicated Pathophysiology

Leukemia treatment is done because the bone marrow is producing increased white blood cells (WBC), more than the usual, acceptable number. These white blood cells that are immaturely produced are pushing on the bone marrow which causes immense pain. Also, these WBCs are crowding out the other major blood components, mainly the red blood cells and the platelets.

Clinical Manifestations

Usually, hospitals would have a maximum of 10,000 WBCs for their laboratory report value. However, clients with leukemia would go as high as 30,000 WBCs. Therefore, the main clinical manifestation in terms of laboratory results is that everything else (platelets and red blood cells) would be low aside from the white blood cell count.

Nursing Management

There are a couple of nursing management and considerations that nurses have to keep in mind when taking care of a client with leukemia.

Radiation and Chemotherapy

These are primarily given to decrease the abnormally high number of white blood cells. Radiation and chemotherapy will technically restart the entire system of producing WBCs because they will wipe out the WBC population – the good and the bad ones.

White blood cells are considered as the soldiers or police officers of the body, and their main objective is to fight off illnesses and infections. Wiping out white blood cells through radiation and chemotherapy would mean that there will be no elements to protect the body from opportunistic viruses and bacteria that could immediately harm the system.

What to expect:

  1. White blood cell count can be less than one or two, resulting in a neutropenic client.
  2. A bone marrow transplant can be given to re-infuse stem cells that can reproduce adequate white blood cells to sustain and maintain the body’s immunity.
  3. Neutropenic precaution will be activated due to increased risk for infection.
    • Prophylactic antibiotics will be given.
    • Hand washing is a must for people who will come in contact with the client, especially families, and
    • Wearing of a mask is required to prevent transport of communicable diseases.
    • Limit visitation privileges.

NCLEX® Question

One favorite NCLEX® question regarding neutropenic precaution would be:

Are flowers and fruits allowed inside the room of a client with leukemia?

Answer: No, flowers and fruits are not allowed.

But, why?

Flowers and fruits go through a process that makes sure sanitation is maintained. This sanitation process sometimes involves chemicals and other harmful elements that, when exposed to a client with leukemia, would cause sickness.

Chemotherapy Reminders

A client who undergoes chemotherapy is technically killing off immature and healthy white blood cells. Some of the side effects of this procedure are:

  1. Alopecia or hair loss
  2. Non-production of epithelial cells inside the mouth that can cause sores and ports of entry
  3. The gastrointestinal lining will be compromised; therefore, inserting rectal thermometers are contraindicated.

That’s it for our leukemia lecture. Check out our other nursing topics on SimpleNursing website and YouTube channel.