TE
RM 02
COMMON HEALTH PROBLEMS IN PRE-SCHOOLERS
LEUKEMIA
• is a malignant hematologic disorder characterized by a
proliferation of abnormal white blood cells (WBCs) that infiltrate
the bone marrow, peripheral blood and organs
• the most common type of childhood cancer
TYPES OF LEUKEMIA
ACUTE
• progresses quickly
• characterized by the proliferation of undifferentiated cells in the
bone marrow
CHRONIC
• slower progression
• uncontrolled expansion of mature cells
MYELOGENOUS OR NON-LYMPHOID LEUKEMIA
• from hemopoietic stem cells
LYMPHOCYTIC OR LYMPHOBLASTIC LEUKEMIA
• arise from any other cells in the bone marrow
SUBTYPES OF LEUKEMIA
ALL: ACUTE LYMPHOCYTIC LEUKEMIA
HEMOPOIESIS AND LYMPHOPOIESIS
• the malignant cell involve is the lymphoblast, an immature
lymphocyte. With the rapid proliferation of lymphocytes, the PLURIPOTENT STEM CELLS
production of RBC and platelets falls, and invasion of body
• Most primitive cells
organs by the rapidly increasing WBC elements begins
• Mature blood cells and lymphocytes develop from pluripotent
cells
• IN CHILDREN:
• The pluripotent stem cells differentiate into either: myeloid
o pallor stem cells or lymphoid stem cells
o low grade fever
• The myeloid stem cells produce progenitors
o Lethargy (symptoms of anemia caused by decreased RBC
• Progenitors lead to the production of mature functional cells
production)
o Petechiae and bleeding from oral mucous membranes and
may bruise easily because of low thrombocyte count LEUKEMIA DEVELOPMENT
o Abdominal pain, vomiting and anorexia as the spleen and • uncontrolled and accelerated production of progenitors which
liver begin to enlarge from infiltration of abnormal cells results in incomplete or defective cell maturation
AML: ACUTE MYELOGENOUS LEUKEMIA • Acute leukemia - rapid proliferation of primitive,
• AML is sometimes referred to as ANLL - acute Nonlymphocytic undifferentiated stem cells
leukemia • Chronic leukemia - differentiated defective cells
• proliferation of precursor cells that have lost the ability to COMMON SYMPTOMS OF LEUKEMIA
differentiate
• It involves the hemopoietic stem cells or pluripotent cells
• results in the gradual accumulation of undifferentiated
cells in marrow or other organs
CLL: CHRONIC LYMPHOCYTIC LEUKEMIA
• proliferation of precursor cells that have lost the ability to
differentiate
• It involves the hemopoietic stem cells or pluripotent cells
• results in the gradual accumulation of undifferentiated cells in
marrow or other organs
CML: CHRONIC MYELOGENOUS LEUKEMIA
• Abnormal hemopoietic stem cells that give rise to cells that have
Philadelphia chromosome
NCM 109: MOTHER AND CHILD AT RISK --- FINALS GILLIAN M.D. 1
, • Anemia : pallor, weakness and irritability o aims to eliminate completely any remaining leukemic cells,
• thrombocytopenia, neutropenia so that the child’s immune system can complete the
• bleeding tendencies: petechiae and bleeding into joints eradication
• Infection: fever o Standard maintenance therapy includes a combination of
• Pain in joints caused by seepage of serous fluid daily 6-mercaptopurine, weekly methotrexate, sporadic
• Tendency toward easy fracture of bones vincristine and prednisone and intrathecal methotrexate
• Enlargement of spleen, liver, and lymph nodes o Continued for 2 to 3 years
o A drug such as Leucovorin is usually given after systemic
• Abdominal pain and anorexia resulting in weight loss
methotrexate, to neutralize its action and protect normal
• Necrosis and bleeding of gums and other mucous membranes
cells from the effect of the drug
• Later symptoms: CNS involvement and frank hemorrhage o During this time, the blood values must be monitored at
least monthly – if there is serious bone marrow depression,
medication levels may be reduced or a transfusion may be
necessary
BONE MARROW TRANSPLANTATION
• COMPLICATIONS
o blindness
o hydrocephalus
o recurrent seizures
o 6th and 7th cranial nerve involvement
o with meningeal involvement (nuchal
o rigidity, headache, irritability, and perhaps
o vomiting and papilledema)
• RENAL INVOLVEMENT
o kidneys may enlarge and function will be impaired
o uric acid crystals
o kidney failure may occur
• TESTICULAR INVASION
THERAPEUTIC INTERVENTION o Sterilization later in life
CHEMOTHERAPY
• often administered by means of a central venous catheter or
port, because administration into a major vessel helps prevent NEPHROBLASTOMA (WILMS’ TUMOR)
irritation to the vessel walls • is a clump of primitive cells that have remained in a child's
• given over a period of 1 month kidney from early cell development. This clump of cells begin to
multiply after birth, forming a large mass of abnormal cells
• INDUCTION PHASE • Wilms' tumor is a cancer of the kidney that affects children
o Vincristine (plant alkaloid) almost exclusively. It's the most common malignant tumor of the
o Prednisone (steroid) kidney in children and it usually occurs about the age of 2 or 3
o L-Asparaginase (enzyme) and rarely after age 8.
o Doxorubicin Hcl (cytotoxic antibiotic)
o Methotrexate (folic acid antagonist)
• Because so many cells are destroyed by chemotherapy, a high
level of uric acid is excreted during treatment which can lead to
plugging of kidney glomeruli and loss of kidney function
o Allopurinol is administered with chemotherapy
o Keeping a child well hydrated also helps maintain safe uric
acid excretion
• CONSOLIDATION OR SANCTUARY PHASE
o A combination of intrathecal administration (injection of the
drug into the CSF by lumbar puncture) of a drug such as
Methotrexate and oral administration of 6-
Mercaptopurine, is next instituted to eradicate the source
of leukemic cells – because many chemotherapy drugs do
not cross the blood-brain barrier in effective
concentrations, leukemic cells continue to flourish even
with remission chemotherapy
• INTENSIFICATION PHASE
• It accounts for more than 20% of solid tumors in childhood;
o Intensifies the assault against leukemic cells using there is no increased incidence based on sex or race
chemotherapeutic agents such as Vincristine, Prednisone,
• It occurs in association with
L-Asparaginase, Doxorubicin, Cyclophosphamide,
Cytosine arabinoside (ARA-C), 6-thioguanine o aniridia (lack of color in the iris),
o cryptorchidism (failure of one or both testes to descend
from the abdominal cavity to the scrotum)
• MAINTENANCE AND MONITORING o hypospadias (urethral defect in which the urethral opening
is not at the end of the penis but on the ventral or lower
aspect of the penis)
NCM 109: MOTHER AND CHILD AT RISK --- FINALS GILLIAN M.D. 2
RM 02
COMMON HEALTH PROBLEMS IN PRE-SCHOOLERS
LEUKEMIA
• is a malignant hematologic disorder characterized by a
proliferation of abnormal white blood cells (WBCs) that infiltrate
the bone marrow, peripheral blood and organs
• the most common type of childhood cancer
TYPES OF LEUKEMIA
ACUTE
• progresses quickly
• characterized by the proliferation of undifferentiated cells in the
bone marrow
CHRONIC
• slower progression
• uncontrolled expansion of mature cells
MYELOGENOUS OR NON-LYMPHOID LEUKEMIA
• from hemopoietic stem cells
LYMPHOCYTIC OR LYMPHOBLASTIC LEUKEMIA
• arise from any other cells in the bone marrow
SUBTYPES OF LEUKEMIA
ALL: ACUTE LYMPHOCYTIC LEUKEMIA
HEMOPOIESIS AND LYMPHOPOIESIS
• the malignant cell involve is the lymphoblast, an immature
lymphocyte. With the rapid proliferation of lymphocytes, the PLURIPOTENT STEM CELLS
production of RBC and platelets falls, and invasion of body
• Most primitive cells
organs by the rapidly increasing WBC elements begins
• Mature blood cells and lymphocytes develop from pluripotent
cells
• IN CHILDREN:
• The pluripotent stem cells differentiate into either: myeloid
o pallor stem cells or lymphoid stem cells
o low grade fever
• The myeloid stem cells produce progenitors
o Lethargy (symptoms of anemia caused by decreased RBC
• Progenitors lead to the production of mature functional cells
production)
o Petechiae and bleeding from oral mucous membranes and
may bruise easily because of low thrombocyte count LEUKEMIA DEVELOPMENT
o Abdominal pain, vomiting and anorexia as the spleen and • uncontrolled and accelerated production of progenitors which
liver begin to enlarge from infiltration of abnormal cells results in incomplete or defective cell maturation
AML: ACUTE MYELOGENOUS LEUKEMIA • Acute leukemia - rapid proliferation of primitive,
• AML is sometimes referred to as ANLL - acute Nonlymphocytic undifferentiated stem cells
leukemia • Chronic leukemia - differentiated defective cells
• proliferation of precursor cells that have lost the ability to COMMON SYMPTOMS OF LEUKEMIA
differentiate
• It involves the hemopoietic stem cells or pluripotent cells
• results in the gradual accumulation of undifferentiated
cells in marrow or other organs
CLL: CHRONIC LYMPHOCYTIC LEUKEMIA
• proliferation of precursor cells that have lost the ability to
differentiate
• It involves the hemopoietic stem cells or pluripotent cells
• results in the gradual accumulation of undifferentiated cells in
marrow or other organs
CML: CHRONIC MYELOGENOUS LEUKEMIA
• Abnormal hemopoietic stem cells that give rise to cells that have
Philadelphia chromosome
NCM 109: MOTHER AND CHILD AT RISK --- FINALS GILLIAN M.D. 1
, • Anemia : pallor, weakness and irritability o aims to eliminate completely any remaining leukemic cells,
• thrombocytopenia, neutropenia so that the child’s immune system can complete the
• bleeding tendencies: petechiae and bleeding into joints eradication
• Infection: fever o Standard maintenance therapy includes a combination of
• Pain in joints caused by seepage of serous fluid daily 6-mercaptopurine, weekly methotrexate, sporadic
• Tendency toward easy fracture of bones vincristine and prednisone and intrathecal methotrexate
• Enlargement of spleen, liver, and lymph nodes o Continued for 2 to 3 years
o A drug such as Leucovorin is usually given after systemic
• Abdominal pain and anorexia resulting in weight loss
methotrexate, to neutralize its action and protect normal
• Necrosis and bleeding of gums and other mucous membranes
cells from the effect of the drug
• Later symptoms: CNS involvement and frank hemorrhage o During this time, the blood values must be monitored at
least monthly – if there is serious bone marrow depression,
medication levels may be reduced or a transfusion may be
necessary
BONE MARROW TRANSPLANTATION
• COMPLICATIONS
o blindness
o hydrocephalus
o recurrent seizures
o 6th and 7th cranial nerve involvement
o with meningeal involvement (nuchal
o rigidity, headache, irritability, and perhaps
o vomiting and papilledema)
• RENAL INVOLVEMENT
o kidneys may enlarge and function will be impaired
o uric acid crystals
o kidney failure may occur
• TESTICULAR INVASION
THERAPEUTIC INTERVENTION o Sterilization later in life
CHEMOTHERAPY
• often administered by means of a central venous catheter or
port, because administration into a major vessel helps prevent NEPHROBLASTOMA (WILMS’ TUMOR)
irritation to the vessel walls • is a clump of primitive cells that have remained in a child's
• given over a period of 1 month kidney from early cell development. This clump of cells begin to
multiply after birth, forming a large mass of abnormal cells
• INDUCTION PHASE • Wilms' tumor is a cancer of the kidney that affects children
o Vincristine (plant alkaloid) almost exclusively. It's the most common malignant tumor of the
o Prednisone (steroid) kidney in children and it usually occurs about the age of 2 or 3
o L-Asparaginase (enzyme) and rarely after age 8.
o Doxorubicin Hcl (cytotoxic antibiotic)
o Methotrexate (folic acid antagonist)
• Because so many cells are destroyed by chemotherapy, a high
level of uric acid is excreted during treatment which can lead to
plugging of kidney glomeruli and loss of kidney function
o Allopurinol is administered with chemotherapy
o Keeping a child well hydrated also helps maintain safe uric
acid excretion
• CONSOLIDATION OR SANCTUARY PHASE
o A combination of intrathecal administration (injection of the
drug into the CSF by lumbar puncture) of a drug such as
Methotrexate and oral administration of 6-
Mercaptopurine, is next instituted to eradicate the source
of leukemic cells – because many chemotherapy drugs do
not cross the blood-brain barrier in effective
concentrations, leukemic cells continue to flourish even
with remission chemotherapy
• INTENSIFICATION PHASE
• It accounts for more than 20% of solid tumors in childhood;
o Intensifies the assault against leukemic cells using there is no increased incidence based on sex or race
chemotherapeutic agents such as Vincristine, Prednisone,
• It occurs in association with
L-Asparaginase, Doxorubicin, Cyclophosphamide,
Cytosine arabinoside (ARA-C), 6-thioguanine o aniridia (lack of color in the iris),
o cryptorchidism (failure of one or both testes to descend
from the abdominal cavity to the scrotum)
• MAINTENANCE AND MONITORING o hypospadias (urethral defect in which the urethral opening
is not at the end of the penis but on the ventral or lower
aspect of the penis)
NCM 109: MOTHER AND CHILD AT RISK --- FINALS GILLIAN M.D. 2
