The term leukemia is defined as cancer of white blood cells which are also referred as leukocytes or WBCS. Normal role of White blood cells is to act as defence mechanism fights against infections. and they are formed in bone marrow .when a child get effected large no of ineffective white blood cells are produced from the bone marrow. These cells form crowds over the health blood cells, making difficult for normal blood cells to perform their usual functions. The abnormal new cells unable to perform their normal role of protecting the body against infection as they are defective. In the later stages of cancer the new cells produce, interrupt the production of other blood cells like red blood cells and platelets along with white blood cells.
FORMATION OF BLOOD CELLS
All the blood cells are formed from blood stem cell in the bone marrow .this takes place in two ways by mitotic and meiosis division
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Stage 1: Blood stem cells undergo first cell division to form Myeloid stem cell and Lymphoid stem cell
Stage2: Myeloid stem cell divide into myeloblast , platelets and red blood cells on the other hand lymphoid stem cell divide into lymphoblast
Stage3; Myeloblast further divide into granulocytes ( eosinophill, basophile and neutrophills) on the other hand lymphoblast divides into B- lymphocytes ,T -lymphocytes and natural killer cells.
Granulocytes and Lymphocytes together constitutes white blood cells (WBC)S.
This shows the development of blood cells. And various steps involved in production of blood cells from single stem cell.
Types of leukemia;
leukemias are classified mainly into two types ACUTE and CHRONIC LEUKEMIA. Acuteleukemia it grows rapidly and Chronic leukemia grows relatively slow. Children with leukemia most often have acute type where as chronic leukemia is rarely seen in children.
Acute childhood leukemia is further divided into two sub groups depending on the specific white blood cells lymphocytes or myelocytes which are linked to immune defence.
a) Acute lymphocytic leukemia (ALL)
b) Acute myelogenous leukemia(AML)
Chronic leukemia is divided into, and it is very rarely seen in children
a) Chronic lymphocytic leukemia(CLL)
b) Chronic myeloid leukemia(CML)
Juvenile myelomonocytic leukemia (JMML)
This rare type of leukemia is neither chronic nor acute. As like in ALL it begins from myeloid cells, and it dose not grow as fast as acute myelogenous leukemia or as slow as chronic myeloid leukemia. It seen mostly in children under age group 4
Most leukemia arises from non-inherited mutations in the genes of growing blood cells, these errors occur randomly and unpredictably.
In cases of identical twins chances of developing ALL or AML is around 20%to25%in case of early diagnosis at age 6.childern with inherent genetic problems like Li-Fraumeni syndrome, Down syndrome, Kleinfelter syndrome, neurofibromatosis, ataxia telangectasia, or Fanconi's anemia - have a higher risk of developing leukemia.
Higher risk of infection is seen in children in their first eight years after treatment who have received prior radiation or chemotherapy for other types of cancer.
Anything that increases the risk of getting disease is called as risk factor risk factors for leukemia include
a) Risk of getting leukemia is high with positive family history
b) There is every chance of infection after been exposed too x-rays before birth
c) Exposure to radiation is also a cause for leukemia
d) Previous treatment with drugs that weakens immune system
e) Sudden changes in genetic makeup like in case of Down syndrome
As leukemia is infection to WBC which are related to defence mechanism child immune system fails to fight against various infections and shows symptoms like fever with or without an infection, anaemia (effect on RBC )which makes them appear pale ,nose bleeding and also bruise and bleed very easily (excess production of blood cells
Other symptoms include:
Appearance of characteristic spots (flat, pinpoint, dark-red spots under skin) named as petechiae.
Pain in joints and or bone.
Lumps in neck, underarm, stomach, or groin which are painless.
Feeling of fullness below the ribs with pain.
Always on Time
Marked to Standard
Feeling tired or weakness.
Loss of appetite.
Physical examination and history:
Diagnosis include examination of signs of infections like anaemia, abnormal bleeding, and swollen lymph nodes.As past health, family's history, previous medications, any allergies reactions, and other medical history of children should be considered.
Various tests that are to be conducted in order to examine the infectious stage are
1) Complete blood count(CBC); A sires of different tests are performed on a blood sample for
a) The number of red blood cells and platelets
b) The number and type of white blood cells
c) The amount of haemoglobin in RBC
d) The percentage count of red blood cells in total blood cells.
2) Bone marrow aspiration and biopsy: In this test a small portion of the bone marrow, blood, and a small piece of bone is taken to examine under microscope for any signs of cancer using a hollow needle inserted into hipbone or breastbone.
3) A lumbar puncture (spinal tap): This done to find out whether the infection has spread to central nervous system(brain and spinal cord) or not .A small amount of spinal fluid is removed from the lower back and examined for evidence of abnormal cells.
4) Cytogenetic analysis: This is a laboratory test in which the cells in a sample of blood or bone marrow are viewed under a microscope to look for certain changes in the chromosomes in the lymphocytes. And other tests like fluorescence in situ hybridization (FISH) may also be done to look for certain changes in chromosomes.
5) Immunophenotyping: A sample of blood or bone marrow cells are looked under microscope to find out if malignant lymphocytes began from the B-lymphocytes or the T-lymphocytes
6) Blood chemistry studies: A procedure in which a blood sample is checked to measure the amount of certain metabolic substance that is released by different organs and tissues into the blood stream.
7)Chest X-ray: X-ray of organ and bones inside the chest are taken using a energy beam that cab go through the body and onto film to make picture of areas inside the body that can be examined for infection
Treatment: First step of treatment begins by addressing the signs and symptoms such as anaemia, bleeding and/or infection. After examine the symptoms various treatment options are considered age and initial white blood cell count place a key role in determining the intensity of treatment is ,and also to achieve the best chances of cure .
Treatment for Leukemia may include following steps depending on the intensity of disease:
Blood and bone marrow transplantation
Biological therapy medications
Chemotherapy: It refers to chemical treatment a combination of drugs that help fight cancer. They administer in three different ways mouth, into the vein, into the muscle or beneath the skin.
Intrathecal medications/chemotherapy: To treat infection in spinal cord medication is inserted into fluid-filled space through a needle to destroy the cancer cells
Radiation therapy: This is a technique in which the patient is exposed to high energy radiations like ultra violet rays and x-rays to kill cancer cells. For treatment of infection in central nervous and other sensitive parts like eye and testes radiation therapy is used.
Blood and marrow transplantation; for children who does not react to standard treatments, a bone marrow transplant may be required. this involves three steps a)collection of Stem cells, immature stem cells are collected from bone marrow of same patient (autologous), or from a close donor whose marrow matches the patient (allogeneic).b) chemotherapy and radiation therapy to destroy left over leukemia cells c) intravenous infusion of healthy stem cell to produce normal blood forming cells.
Biological therapy: This treatment is to protect other cells or organs from damage cells by treatment with infusion relative large doses of hormones or other proteins.
Blood transfusions: anaemia patients cannot make their own red blood cells. Various blood cells like platelets, white blood cells, plasma are transfused to keep normal properties of blood
Antibiotics: Different types of antibiotics are used to prevent further spared of infection.
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Generally treatment of leukemia is given for long time it may takes months to years for complete recovery as there is every chances of reoccurrence and involves three or more stages,
Induction: This is the first stage of treatment in this a combination of chemotherapeutic drugs is administered to reduce the total number of infectious cells to less than 5% of their total in order to provide room for the return of fresh blood cells including red blood cells and platelets. This stage is also called as remission and this phase may last for one month can be repeated if goal is no achieved.
Consolidation; This involves drug therapy, which may last for one to months, after this we can still expect leukemia cells which are not detectable in blood test and on marrow examination
Intensification: It involves prolonged treatment of chemotherapy drugs of same strength and potency to those used in induction and consolidation. Sometimes a bone marrow or stem cell transplantation or higher-dose chemotherapy may be required depending on the patientâ€™s reaction to treatment.
Maintenance: This stage involves prolong maintaining dose medications of less potent chemotherapy drugs in order to further reduce the leukemia cells. In this courses drugs administered periodically every 28 days for 18 to 30 months for girls and boys respectively. To prevent any reoccurrence of disease and to manage any side effects of treatment it is preferable to have a regular check up.