What is the nursing process for leukemia and is the disease treated? The need for a blood transfusion. The course and clinical forms of acute leukemia, acute leukemia

Leukemia- a systemic blood disease characterized by the following features: 1) progressive cellular hyperplasia in the hematopoietic organs, and often in peripheral blood with a sharp predominance of proliferative processes over the processes of normal differentiation of blood cells; 2) metaplastic growth of various pathological elements, developing from the original cells, constituting the morphological essence of a particular type of leukemia.

Diseases of the blood system are hemoblastoses, which are analogous to tumor processes in other organs. Some of them primarily develop in the bone marrow and are called leukemias. And the other part primarily occurs in the lymphoid tissue of the hematopoietic organs and is called lymphomas or hematosarcomas.

Leukemia is a polyetiological disease. Each person may have different factors that caused the disease. There are four groups:

1 group- infectious-viral causes;

2 group- hereditary factors. It is confirmed by observation of leukemia families, where one of the parents is ill with leukemia. According to statistics, there is either direct or one-generation transmission of leukemia.

3 group- the action of chemical leukemia factors: cytostatics in the treatment of cancer lead to leukemia, antibiotics of the penicillin series and cephalosporins. These medicines should not be abused.
Industrial and household chemicals (carpets, linoleum, synthetic detergents, etc.)

4 group- Radiation exposure.

Primary period of leukemia (latent period - the time from the moment of action of the etiological factor that caused leukemia to the first signs of the disease. This period can be short (several months), or it can be long (tens of years).
There is a multiplication of leukemia cells, from the first single to such an amount that causes oppression of normal hematopoiesis. Clinical manifestations depend on the rate of reproduction of leukemic cells.

Secondary period (the period of a detailed clinical picture of the disease). The first signs are often detected in the laboratory. There can be two situations:

A) the patient's state of health does not suffer, there are no complaints, but signs (manifestation) of leukemia are noted in the blood;

B) there are complaints, but there are no changes in the cells.

Clinical signs

Leukemia has no characteristic clinical signs, they can be any. Depending on the oppression of hematopoiesis, the symptoms manifest themselves in different ways.

For example, the granulocytic germ (granulocyte - neutrophil) is depressed, one patient will have pneumonia, the other will have tonsillitis, pyelonephritis, meningitis, etc.

All clinical manifestations are divided into 3 groups of syndromes:

1) infectious-toxic syndrome, manifested in the form of various inflammatory processes and is caused by inhibition of the granulocytic germ;

2) hemorrhagic syndrome, manifested by increased bleeding and the possibility of hemorrhages and blood loss;

3) anemic syndrome, manifested by a decrease in the content of hemoglobin, erythrocytes. Appears pallor of the skin, mucous membranes, fatigue, shortness of breath, dizziness, decreased cardiac activity.

Acute leukemia

Acute leukemia is a malignant tumor of the blood system. The main substrate of the tumor are young, so-called blast cells. Depending on the morphology and cytochemical parameters of cells in the group of acute leukemia, there are: acute myeloblastic leukemia, acute monoblastic leukemia, acute myelomonoblastic leukemia, acute promyelocytic leukemia, acute erythromyelosis, acute megakaryoblastic leukemia, acute undifferentiated leukemia, acute lymphoblastic leukemia.

During acute leukemia, several stages are distinguished:

1) initial;

2) deployed;

3) remission (complete or incomplete);

4) relapse;

5) terminal.

initial stage acute leukemia is diagnosed most often when patients with previous anemia develop a picture of acute leukemia in the future.

Expanded stage characterized by the presence of the main clinical and hematological manifestations of the disease.

Remission may be complete or incomplete. Complete remission includes conditions in which there are no clinical symptoms of the disease, the number of blast cells in the bone marrow does not exceed 5% in the absence of them in the blood. The composition of peripheral blood is close to normal. With incomplete remission, there is a clear clinical and hematological improvement, but the number of blast cells in the bone marrow remains elevated.

relapse acute leukemia can occur in the bone marrow or outside bone marrow(leather, etc.). Each subsequent relapse is prognostically more dangerous than the previous one.

terminal stage acute leukemia is characterized by resistance to cytostatic therapy, severe inhibition of normal hematopoiesis, development of ulcerative necrotic processes.

IN clinical course of all forms, there are much more common "acute leukemia" features than differences and features, but the differentiation of acute leukemia is important for predicting and choosing cytostatic therapy. Clinical symptoms are very diverse and depend on the localization and massiveness of leukemic infiltration and on signs of suppression of normal hematopoiesis (anemia, granulocytopenia, thrombocytopenia).

The first manifestations of the disease are of a general nature: weakness, loss of appetite, sweating, malaise, fever of the wrong type, pain in the joints, the appearance of small bruises after minor injuries. The disease can begin acutely - with catarrhal changes in the nasopharynx, tonsillitis. Sometimes acute leukemia is detected by a random blood test.

In the advanced stage of the disease, several syndromes can be distinguished in the clinical picture: anemic syndrome, hemorrhagic syndrome, infectious and ulcerative-necrotic complications.

Anemic syndrome is manifested by weakness, dizziness, pain in the heart, shortness of breath. Objectively marked pallor skin and mucous membranes. The severity of anemia is different and is determined by the degree of inhibition of erythropoiesis, the presence of hemolysis, bleeding, and so on.

Hemorrhagic syndrome occurs in almost all patients. Gingival, nasal, uterine bleeding, hemorrhage on the skin and mucous membranes are usually observed. at injection sites and intravenous injections extensive hemorrhages occur. In the terminal stage, ulcerative necrotic changes appear at the site of hemorrhages in the mucous membrane of the stomach and intestines. The most pronounced hemorrhagic syndrome is observed in promyelocytic leukemia.

Infectious and ulcerative-necrotic complications are a consequence of granulocytopenia, a decrease in the phagocytic activity of granulocytes and occur in more than half of patients with acute leukemia. Pneumonia, sore throats, infections often occur urinary tract, abscesses at injection sites. The temperature can be different - from subfebrile to constantly high. A significant increase in lymph nodes in adults is rare, in children it is quite common. Lymphadenopathy is especially characteristic for lymphoblastic leukemia. More often, lymph nodes in the supraclavicular and submandibular regions increase. On palpation, the lymph nodes are dense, painless, may be slightly painful when rapid growth. An increase in the liver and spleen is not always observed, mainly with lymphoblastic leukemia.

In the peripheral blood, most patients have normochromic anemia, less often hyperchromic type. Anemia deepens with the progression of the disease up to 20 g/l, and the number of erythrocytes is below 1.0 g/l. Anemia is often the first manifestation of leukemia. The number of reticulocytes is also reduced. The number of leukocytes is usually increased, but does not reach such high numbers as with chronic leukemia. The number of leukocytes varies widely from 0.5 to 50 - 300 g / l.

Forms of acute leukemia with high leukocytosis are prognostically less favorable. Forms of leukemia are observed, which from the very beginning are characterized by leukopenia. Total blast hyperplasia in this case occurs only in the terminal stage of the disease.

For all forms of acute leukemia, a decrease in the number of platelets to 15–30 g/l is characteristic. Especially pronounced thrombocytopenia is observed in the terminal stage.

IN leukocyte formula- blast cells up to 90% of all cells and a small number of mature elements. The release of blast cells into the peripheral blood is the main morphological sign of acute leukemia. To differentiate the forms of leukemia, in addition to morphological features, cytochemical studies are used (lipid content, peroxidase activity, glycogen content, acid phosphatase activity, nonspecific esterase activity, etc.)

Acute promyelocytic leukemia is characterized by an extremely malignant process, a rapid increase in severe intoxication, pronounced hemorrhagic syndrome leading to cerebral hemorrhage and death of the patient.

Tumor cells with coarse granularity in the cytoplasm make it difficult to determine the structures of the nucleus. Positive cytochemical signs: peroxidase activity, a lot of lipids and glycogen, a sharply positive reaction to acid phosphatase, the presence of glycosaminoglycan.

Hemorrhagic syndrome depends on severe hypofibrinogenemia and excess content thromboplastin in leukemic cells. The release of thromboplastin provokes intravascular coagulation.

Acute myeloid leukemia is characterized by a progressive course, severe intoxication and fever, early onset clinical and hematological decompensation of the process in the form of severe anemia, moderate intensity of hemorrhagic manifestations, frequent ulcerative necrotic lesions of the mucous membranes and skin.

Myeloblasts predominate in the peripheral blood and bone marrow. Cytochemical examination reveals peroxidase activity, an increase in lipid content, and low activity of nonspecific esterase.

Acute lymphomooblastic leukemia is a subtype of acute myeloid leukemia. According to the clinical picture, they are almost identical, but the myelomonoblastic form is more malignant, with more pronounced intoxication, profound anemia, thrombocytopenia, more pronounced hemorrhagic syndrome, frequent necrosis of the mucous membranes and skin, hyperplasia of the gums and tonsils. In the blood, blast cells are detected - large, irregular shape, with a young nucleus resembling the nucleus of a monocyte in shape. In a cytochemical study in cells, a positive reaction to peroxidase, glycogen and lipids is determined. A characteristic feature is a positive reaction to nonspecific esterase in cells and lysozyme in serum and urine.

The average life expectancy of patients is half that of myeloblastic leukemia. The cause of death is usually infectious complications.

Acute monoblastic leukemia is a rare form of leukemia. The clinical picture resembles acute myeloid leukemia and is characterized by an anemic tendency to hemorrhages, enlarged lymph nodes, enlarged liver, ulcerative necrotic stomatitis. In the peripheral blood - anemia, thrombocytopenia, lymphomonocytic profile, increased leukocytosis. Young blast cells appear. Cytochemical studies in cells show a weakly positive reaction to lipids and high activity of nonspecific esterase. Treatment rarely causes clinical and hematological remissions. The life expectancy of the patient is about 8-9 months.

Acute lymphoblastic leukemia is more common in children and in individuals young age. Characterized by an increase in any group of lymph nodes, spleen. The state of health of patients does not suffer, intoxication is expressed moderately, anemia is insignificant. Hemorrhagic syndrome is often absent. Patients complain of pain in the bones. Acute lymphoblastic leukemia differs in frequency neurological manifestations(neuroleukemia).

In the peripheral blood and in the punctate-lymphoblast, young large cells with a rounded nucleus. Cytochemical examination: the reaction to peroxidase is always negative, lipids are absent, glycogen in the form of large granules.

A hallmark of lymphoblastic acute leukemia is a positive response to the therapy used. The frequency of remission -- from 50% to 90%. Remission is achieved by using a complex of cytostatic agents. Relapse of the disease can be manifested by neuroleukemia, infiltration of nerve roots, bone marrow tissue. Each subsequent relapse has a worse prognosis and is more malignant than the previous one. In adults, the disease is more severe than in children.

Erythromyelosis is characterized by the fact that the pathological transformation of hematopoiesis concerns both white and red sprouts of the bone marrow. In the bone marrow, young undifferentiated cells of the white row and blast anaplastic cells of the red germ are found - erythro- and normoblasts in large numbers. Large red cells have an ugly appearance.

In the peripheral blood - persistent anemia, anisocytosis of erythrocytes (macrocytes, megalocytes), poikilocytosis, polychromasia and hyperchromia. Erythro- and normoblasts in peripheral blood - up to 200-350 per 100 leukocytes. Leukopenia is often noted, but there may be a moderate increase in leukocytes up to 20–30 g/l. As the disease progresses, blast forms-monoblasts appear. Lymphadenopathy is not observed, the liver and spleen may be enlarged or remain normal. The disease proceeds longer than the myeloblastic form, in some cases it is noted subacute course erythromyelosis (up to two years without treatment).

The duration of continuous maintenance therapy should be at least 3 years. For early detection of recurrence, it is necessary to perform control studies bone marrow at least 1 time per month in the first year of remission and 1 time in 3 months after a year of remission. During the period of remission, the so-called immunotherapy can be carried out, aimed at destroying the remaining leukemic cells using immunological methods. Immunotherapy consists of administering the BCG vaccine or allogeneic leukemic cells to patients.

Relapse of lymphoblastic leukemia is usually treated with the same combinations of cytostatics as during the induction period.

With non-lymphoblastic leukemia, the main task is usually not to achieve remission, but to contain the leukemic process and prolong the life of the patient. This is due to the fact that non-lymphoblastic leukemias are characterized by a sharp inhibition of normal hematopoietic sprouts, and therefore intensive cytostatic therapy is often impossible.

For the induction of remission in patients with non-lymphoblastic leukemia, combinations of cytostatic drugs are used; cytosine-arabinoside, daunomycin: cytosine - arabinoside, thioguanine; cytosine-arabinoside, oncovin (vincristine), cyclophosphamide, prednisolone. The course of treatment lasts 5-7 days followed by 10-14 afternoon break necessary to restore normal hematopoiesis, inhibited by cytostatics. Maintenance therapy is carried out with the same drugs or their combinations used during the induction period. Almost all patients with non-lymphoblastic leukemia develop a relapse, requiring a change in the combination of cytostatics.

An important place in the treatment of acute leukemia is occupied by the therapy of extramedullary localizations, among which the most frequent and formidable is neuroleukemia (meningo-encephalitic syndrome: nausea, vomiting, unbearable headache; syndrome of local damage to the substance of the brain; pseudotumor focal symptoms; disorder of the functions of the cranial nerves oculomotor, auditory, facial and trigeminal nerves; leukemic infiltration of nerve roots and trunks: polyradiculoneuritis syndrome). The method of choice for neuroleukemia is the intralumbar administration of methotrexate and head irradiation at a dose of 2400 rad. In the presence of extramedullary leukemic foci (nasopharynx, testis, lymph nodes of the mediastinum, etc.), causing compression of organs and pain, local radiation therapy is indicated in a total dose of 500-2500 rad.

Infections are treated with antibiotics a wide range actions directed against the most common pathogens - Pseudomonas aeruginosa, Escherichia coli, Staphylococcus aureus. Apply carbenicillin, gentamicin, tseporin. Antibiotic therapy is continued for at least 5 days. Antibiotics should be given intravenously every 4 hours.

To prevent infectious complications, especially in patients with granulocytopenia, careful care of the skin and oral mucosa, placement of patients in special aseptic wards, intestinal sterilization with non-absorbable antibiotics (kanamycin, rovamycin, neoleptsin) is necessary. The main treatment for hemorrhage in patients with acute leukemia is platelet transfusion. At the same time, the patient is transfused with 200-10,000 g/l of platelets 1-2 times a week. In the absence of platelet mass, fresh whole blood can be transfused for hemostatic purposes or direct transfusion can be used. In some cases, to stop bleeding, the use of heparin (in the presence of intravascular coagulation), epsilon-aminocaproic acid (with increased fibronolysis) is indicated.

Modern programs for the treatment of lymphoblastic leukemia make it possible to obtain complete remissions in 80-90% of cases. The duration of continuous remissions in 50% of patients is 5 years or more. In the remaining 50% of patients, therapy is ineffective and relapses develop. With non-lymphoblastic leukemia, complete remissions are achieved in 50--60% of patients, but relapses develop in all patients. The average life expectancy of patients is 6 months. The main causes of death are infectious complications, severe hemorrhagic syndrome, neuroleukemia.

Chronic myeloid leukemia

The substrate of chronic myeloid leukemia is mainly maturing and mature cells of the granulocytic series (metamyelocytes, stab and segmented granulocytes). The disease is one of the most common in the group of leukemias, occurs rarely in people aged 20-60 years, in the elderly and children and lasts for years.

The clinical picture depends on the stage of the disease.

There are 3 stages of chronic myeloid leukemia - initial, advanced and terminal.

In the initial stage chronic myeloid leukemia is practically not diagnosed or detected by a random blood test, since there are almost no symptoms during this period. Attention is drawn to the constant and unmotivated leukocytosis with a neutrophilic profile, a shift to the left. The spleen enlarges, causing discomfort in the left hypochondrium, a feeling of heaviness, especially after eating. Leukocytosis increases to 40--70 g/l. An important hematological sign is an increase in the number of basophils and eosinophils of different maturity. Anemia is not observed during this period. Thrombocytosis up to 600-1500 g/l is noted. In practice, this stage cannot be distinguished. The disease, as a rule, is diagnosed at the stage of total generalization of the tumor in the bone marrow, i.e., in the advanced stage.

Expanded stage characterized by the appearance of clinical signs of the disease associated with the leukemic process. Patients report fatigue, sweating, subfebrile temperature, weight loss. There are heaviness and pain in the left hypochondrium, especially after walking. With an objective study, an almost constant sign during this period is an enlargement of the spleen, which in some cases reaches a significant size. On palpation, the spleen remains painless. Half of the patients develop splenic infarcts, manifested sharp pains in the left hypochondrium with irradiation to the left side, left shoulder, aggravated by deep inspiration.

The liver is also enlarged, but its size is individually variable. Functional disturbances of a liver are expressed slightly. Hepatitis manifests itself dyspeptic disorders, jaundice, an increase in the size of the liver, an increase in direct bilirubin in the blood. Lymphadenopathy in the advanced stage of chronic myeloid leukemia is rare, hemorrhagic syndrome is absent.

There may be violations of the cardiovascular system (pain in the heart, arrhythmia). These changes are due to intoxication of the body, increasing anemia. Anemia has a normochromic character, aniso- and poikilocytosis is often expressed. The leukocyte formula contains the entire granulocytic series, including myeloblasts. The number of leukocytes reaches 250-500 g/l. The duration of this stage without cytostatic therapy is 1.5-2.5 years. The clinical picture changes markedly during treatment. The state of health of patients remains satisfactory for a long time, working capacity is maintained, the number of leukocytes is 10–20 g/l, there is no progressive enlargement of the spleen. The extended stage in patients taking cytostatics lasts 4-5 years, and sometimes more.

In the terminal stage noted sharp deterioration general condition, increased sweating, persistent unmotivated fever. There are severe pains in the bones and joints. An important sign is the appearance of refractoriness to ongoing therapy. Significantly enlarged spleen. Anemia and thrombocytopenia are on the rise. With a moderate increase in the number of leukocytes, the formula is rejuvenated by increasing the percentage of immature cells (promyelocytes, myeloblasts and undifferentiated).

Hemorrhagic syndrome, which was absent in the advanced stage, almost always appears in the terminal period. Tumor process in the terminal stage, it begins to spread beyond the bone marrow: leukemic infiltration of the nerve roots occurs, causing radicular pain, subcutaneous leukemic infiltrates (leukemids) are formed, sarcoma growth is observed in the lymph nodes. Leukemic infiltration on the mucous membranes contributes to the development of hemorrhages in them, followed by necrosis. In the terminal stage, patients are prone to the development of infectious complications, which are often the cause of death.

The differential diagnosis of chronic myeloid leukemia should be carried out primarily with leukemoid reactions of the myeloid type (as a result of the body's response to infection, intoxication, etc.). The blast crisis of chronic myeloid leukemia can give a picture resembling acute leukemia. In this case, anamnestic data testify in favor of chronic myeloid leukemia, severe splenomegaly the presence of the Philadelphia chromosome in the bone marrow.

The treatment of chronic myeloid leukemia in the advanced and terminal stages has its own differences.

In the advanced stage, therapy is aimed at reducing weight tumor cells and aims to preserve the somatic compensation of patients as long as possible and delay the onset of a blast crisis. The main drugs used in the treatment of chronic myelogenous leukemia: myelosan (mileran, busulfan), myelobromol (dibromomannitol), hexophosphamide, dopan, 6-mercaptopurine, radiation therapy 1500-2000 times.

The patient is recommended to eliminate overloads, stay outdoors as much as possible, quit smoking and drinking alcohol. Recommended meat products, vegetables, fruits. Stay (sunbathing) in the sun is excluded. Thermal, physio- and electrical procedures are contraindicated. In case of a decrease in red blood indicators, hemostimulin, ferroplex are prescribed. Courses of vitamin therapy B1, B2, B6, C, PP.

Contraindications to irradiation are blast crisis, severe anemia, thrombocytopenia.

When a therapeutic effect is achieved, they switch to maintenance doses. X-ray therapy and cytostatics should be used against the background of weekly blood transfusions of 250 ml of one-group blood and the corresponding Rh accessories.

Treatment in the terminal stage of chronic myeloid leukemia in the presence of blast cells in the peripheral blood is carried out according to the schemes of acute myeloid leukemia. VAMP, CAMP, AVAMP, COAP, a combination of vincristine with prednisolone, cytosar with rubomycin. Therapy is aimed at prolonging the life of the patient, since it is difficult to get remission in this period.

The prognosis of this disease is unfavorable. The average life expectancy is 4.5 years, in some patients it is 10-15 years.

Benign subleukemic myelosis

Benign subleukemic myelosis is an independent nosological form among tumors. hematopoietic system. The tumor substrate consists of mature cells of one, two or all three bone marrow sprouts - granulocytes, platelets, less often erythrocytes. Hyperplasia of myeloid tissue (myelosis) develops in the bone marrow, connective tissue(myelofibrosis), there is a neoplasm of pathological osteoid tissue (osteomyelosclerosis). Growth in the bone marrow fibrous tissue is reactive. Gradually, the development of myelofibrosis leads in the terminal stages of the disease to the replacement of the entire bone marrow with scar connective tissue.

It is diagnosed mainly in old age. For a number of years, patients do not show any complaints. As the disease progresses, weakness, fatigue, sweating, discomfort and heaviness in the abdomen appear, especially after eating. There is reddening of the face, pruritus, heaviness in the head. The main early symptom is enlargement of the spleen, enlargement of the liver is usually not so pronounced. Hepatosplenomegaly can lead to portal hypertension. A frequent symptom of the disease is bone pain, which is observed in all stages of the disease, and sometimes long time are the only manifestation of it. Despite the high content of platelets in the blood, hemorrhagic syndrome is observed, which is explained by the inferiority of platelets, as well as a violation of blood coagulation factors.

In the terminal stage of the disease, fever, exhaustion, anemia increase, pronounced hemorrhagic syndrome, and sarcoma growth in tissues are noted.

Changes in the blood in patients with benign subleukemic myelosis resemble the picture of "subleukemic" chronic myeloid leukemia. Leukocytosis does not reach high numbers and rarely exceeds 50 g / l. In the blood formula - a shift to the left to metamyelocytes and myelocytes, an increase in the number of basophils. Hyperthrombocytosis can reach 1000 g/l or more. At the beginning of the disease, there may be an increase in the number of red blood cells, which later normalizes. The course of the disease can be complicated hemolytic anemia autoimmune origin. In the bone marrow, hyperplasia of granulocytic, platelet and erythroid sprouts is observed along with fibrosis and osteomyelosclerosis. In the terminal stage, there may be an increase in blast cells - a blast crisis, which, unlike chronic myeloid leukemia, is rare.

With small changes in the blood, slow growth of the spleen and liver active treatment not carried out. Indications for cytostatic therapy are: 1) a significant increase in the number of platelets, leukocytes or erythrocytes in the blood, especially with the development of relevant clinical manifestations (hemorrhages, thrombosis); 2) the predominance of cellular hyperplasia in the bone marrow over the processes of fibrosis; 3) hypersplenism.

In benign subleukemic myelosis, myelosan 2 mg daily or every other day, myelobromol 250 mg 2-3 times a week, imifos 50 mg every other day are used. The course of treatment is carried out for 2-3 weeks under the control of blood counts.

Glucocorticoid hormones are prescribed for insufficiency of hematopoiesis, autoimmune hemolytic crises, hypersplenism.

With significant splenomegaly, irradiation of the spleen in doses of 400-600 rad can be applied. For the treatment of anemic syndrome, anabolic hormones, red blood cell transfusions are used. Physio-, electro-, thermal procedures are contraindicated for patients. The prognosis is generally relatively favorable, patients can live for many years and decades in a state of compensation.

erythremia

Erythremia (Wakez's disease) true polycythemia) - chronic leukemia, belongs to the group benign tumors blood systems. Tumor proliferation of all hematopoietic germs, especially the erythroid germ, is observed, which is accompanied by an increase in the number of red blood cells (in some cases, leukocytes and platelets), hemoglobin mass and viscosity of circulating blood, and an increase in blood coagulation. An increase in the mass of erythrocytes in the bloodstream and vascular depots determines the features of clinical symptoms, the course and complications of the disease.

Erythremia occurs predominantly in the elderly. There are 3 stages of the course of the disease: initial, deployed (erythremic) and terminal.

In the initial stage, patients usually complain of heaviness in the head, tinnitus, dizziness, increased fatigue, decreased mental performance, chilliness of the limbs, sleep disturbance. External characteristic signs may be absent.

The expanded stage is characterized by more vivid clinical symptoms. The most common and characteristic symptom is headaches, which sometimes have the character of excruciating migraines with visual impairment.

Many patients complain of pain in the region of the heart, sometimes such as angina pectoris, pain in the bones, in the epigastric region, weight loss, impaired vision and hearing, unstable mood, tearfulness. A common symptom of erythremia is pruritus. Can be paroxysmal pain at the tips of the fingers and toes. Pain is accompanied by reddening of the skin.

On examination, the typical red-cyanotic color of the skin with a predominance of a dark cherry tone attracts attention. There is also redness of the mucous membranes (conjunctiva, tongue, soft palate). In connection with frequent thrombosis of the extremities, darkening of the skin of the legs is observed, sometimes trophic ulcers. Many patients complain of bleeding gums, bleeding after tooth extraction, bruising on the skin. In 80% of patients, there is an increase in the spleen: in the advanced stage, it is moderately enlarged, in the terminal stage, severe splenomegaly is often observed. The liver is usually enlarged. Often in patients with erythremia, an increase in blood pressure. Hypertension in erythremia is characterized by more pronounced cerebral symptoms. As a result of a violation of the trophism of the mucous membrane and vascular thrombosis, ulcers of the duodenum and stomach may occur. An important place in the clinical picture of the disease is occupied by vascular thrombosis. Thrombosis of the cerebral and coronary arteries, as well as blood vessels, is usually observed. lower extremities. Along with thrombosis, patients with erythremia are prone to the development of hemorrhages.

In the terminal stage, the clinical picture is determined by the outcome of the disease - liver cirrhosis, coronary thrombosis, softening focus in the brain due to thrombosis cerebral vessels and hemorrhages, myelofibrosis, accompanied by anemia, chronic myeloid leukemia and acute leukemia.

In the peripheral blood in the initial stage of the disease, only moderate erythrocytosis can be observed. A characteristic hematological sign of the advanced stage of erythremia is an increase in the number of erythrocytes, leukocytes, and platelets in the blood (pancytosis). The most typical for erythremia is an increase in the number of erythrocytes up to 6-7 g/l and hemoglobin up to 180-220 g/l. In parallel with an increase in erythrocytes and hemoglobin, an increase in hematocrit is noted.

An increase in the dense part of the blood and its viscosity leads to sharp decline ESR up to the complete absence of erythrocyte sedimentation. The number of leukocytes increased slightly - up to 15-18 g/l. The formula reveals neutrophilia with a stab shift, less often metamyelocytes and myelocytes appear. The number of thrombocytes is increased to 1000 g/l.

Albuminuria is constantly found, sometimes hematuria. In the terminal stage, the blood picture depends on the outcome of erythremia. During the transition to myelofibrosis or myeloid leukemia, the number of leukocytes increases, shift to the left, normocytes appear, the number of erythrocytes decreases. In the case of acute leukemia, blast cells are detected in the blood, anemia and thrombocytopenia are constantly encountered.

In the bone marrow of patients with an advanced stage of erythremia, a typical sign is hyperplasia of all 3 sprouts (panmyelosis) with severe megakaryocytosis. In the terminal stage, myelofibrosis is observed with persistent megakaryocytosis. The main difficulties lie in differential diagnosis erythremia with secondary symptomatic erythrocytosis. There are absolute and relative erythrocytosis. Absolute erythrocytosis is characterized by increased activity of erythropoiesis and an increase in the mass of circulating erythrocytes. With relative erythrocytosis, there is a decrease in plasma volume and a relative predominance of erythrocytes per unit volume of blood. The mass of circulating erythrocytes with relative erythrocytosis is not changed.

Absolute erythrocytosis occurs in hypoxic conditions (lung diseases, congenital heart disease, altitude sickness), tumors (hypernephroma, adrenal tumors, hepatoma), some kidney diseases (polycystic, hydronephrosis).

Relative erythrocytosis occurs mainly when pathological conditions associated with increased loss fluids (prolonged vomiting, diarrhea, burns, excessive sweating).

In the initial stages of the disease, occurring without pronounced pancytosis, bloodletting of 300–600 ml is indicated 1–3 times a month.
The bleeding effect is unstable. With systematic bloodletting, iron deficiency may develop. In the advanced stage of erythremia in the presence of pancytosis, the development of thrombotic complications, cytostatic therapy is indicated. The most effective cytostatic drug in the treatment of erythremia is imifos. The drug is administered intramuscularly or intravenously at a dose of 50 mg daily for the first 3 days, and then every other day. For the course of treatment - 400-600 mg. The effect of imifos is determined after 1.5-2 months, since the drug acts at the level of the bone marrow. In some cases, anemia develops, which usually gradually disappears on its own. With an overdose of imiphos, hematopoietic hypoplasia may occur, for the treatment of which prednisolone, nerobol, vitamin B6 and B12, as well as blood transfusions are used. The average duration of remission is 2 years, maintenance therapy is not required. With a recurrence of the disease, sensitivity to imiphos persists. With increasing leukocytosis, rapid growth of the spleen, myelobromol is prescribed at a dose of 250 mg for 15-20 days. Less effective in the treatment of erythremia myelosan. As symptomatic remedies treatment of erythremia using anticoagulants, antihypertensive drugs, aspirin.

The prognosis is relatively favorable. The total duration of the disease in most cases is 10-15 years, and in some patients it reaches 20 years. Significantly worsen the prognosis are vascular complications that can cause death, as well as the transformation of the disease into myelofibrosis or acute leukemia.

Chronic lymphocytic leukemia

Chronic lymphocytic leukemia is a benign tumor disease of the lymphoid (immunocompetent) tissue, which, unlike other forms of leukemia, does not show tumor progression throughout the course of the disease. The main morphological substrate of the tumor is mature lymphocytes, which proliferate and accumulate in increased numbers in the lymph nodes, spleen, liver, and bone marrow. Among all leukemias, chronic lymphocytic leukemia occupies a special place. Despite the morphological maturity of lymphocytes, they are functionally inferior, which is expressed in a decrease in immunoglobulins. The defeat of the immunocompetent system causes the tendency of patients to infections and the development of autoimmune anemia, thrombocytopenia, less often - granulocytopenia. The disease occurs mainly in the elderly, more often in men, often occurs in blood relatives.

The disease begins gradually without severe clinical symptoms. Often the diagnosis is made for the first time with a random blood test, an increase in the number of leukocytes, the presence of lymphocytosis is detected. Gradually appear weakness, fatigue, sweating, weight loss. There is an increase in peripheral lymph nodes, mainly in the cervical, axillary and inguinal regions. Subsequently, the mediastinal and retroperitoneal lymph nodes are affected. On palpation, peripheral lymph nodes of a soft or doughy consistency are determined, not soldered to each other and the skin, painless. The spleen is significantly enlarged, dense, painless. The liver is most often enlarged. From the side gastrointestinal tract diarrhea is noted.

There is no hemorrhagic syndrome in a typical uncomplicated form. Skin lesions are much more common than in other forms of leukemia. Skin changes may be specific or non-specific. Nonspecific include eczema, erythroderma, psoriatic rashes, pemphigus.

Specific ones are leukemic infiltration of the papillary and subpapillary dermis. Skin infiltration can be focal or generalized.

One of the clinical features of chronic lymphocytic leukemia is the reduced resistance of patients to bacterial infections. Among the most frequent infectious complications are pneumonia, urinary tract infections, tonsillitis, abscesses, septic condition.

A severe complication of the disease is autoimmune processes associated with the appearance of antibodies against antigens of one's own blood cells. The most common is autoimmune hemolytic anemia.

Clinically, this process is manifested by a deterioration in the general condition, an increase in body temperature, the appearance of mild jaundice, and a decrease in hemoglobin. Autoimmune thrombocytopenia accompanied by hemorrhagic syndrome may be observed. Less common is autoimmune lysis of leukocytes.

Chronic lymphocytic leukemia can transform into hematosarcoma - the gradual transformation of enlarged lymph nodes into a dense tumor, a pronounced pain syndrome, a sharp deterioration in the general condition.

There are several forms of chronic lymphocytic leukemia:

1) a typical benign form of the disease with a generalized enlargement of the lymph nodes, moderate hepatosplenomegaly, leukemic blood picture, absence of anemia, rare infectious and autoimmune disorders. This form occurs most often and is characterized by a long and favorable course;

2) a malignant variant that differs severe course, the presence of dense lymph nodes forming conglomerates, high leukocytosis, inhibition of normal hematopoiesis, frequent infectious complications;

3) splenomegalic form, often occurring without peripheral lymphadenopathies, often with an increase in abdominal lymph nodes. The number of leukocytes is within the normal range or slightly reduced. Rapidly growing anemia is characteristic;

4) bone marrow form with an isolated lesion of the bone marrow, a leukemic blood picture, and the absence of enlarged lymph nodes and spleen. Often develops anemia, thrombocytopenia with hemorrhagic syndrome;

5) the cutaneous form (Cesari's syndrome) proceeds with predominant leukemic infiltration of the skin;

6) forms with an isolated increase in individual groups of lymph nodes and the presence of appropriate clinical symptoms.

Changes in the peripheral blood are characterized by high leukocytosis up to 20-50 and 100 g/l. Sometimes the number of leukocytes is slightly increased. Lymphocytes make up 60-90% of all shaped elements. The bulk is mature lymphocytes, 5--10% are prolymphocytes. Characteristic of chronic lymphocytic leukemia is the presence of a large number of dilapidated nuclei of lymphocytes with remnants of nucleolus - the "shadow" of Botkin-Gumprecht.

In case of transformation of chronic lymphocytic leukemia into hemosarcoma, lymphocytosis is replaced by neutrophilia.

In the myelogram of patients with chronic lymphocytic leukemia, a sharp increase in the percentage of mature lymphocytes is revealed up to complete metaplasia of the bone marrow by lymphocytes.

In the blood serum, there is a decrease in the content of gamma globulins.

In chronic lymphocytic leukemia, cytostatic and radiation therapy are performed to reduce the mass of leukemia cells. Symptomatic treatment, aimed at combating infectious and autoimmune complications, includes antibiotics, gamma globulin, antibacterial immune sera, steroid drugs, anabolic hormones, blood transfusions, splenectomy.

If you feel unwell with a benign form, a course of vitamin therapy is recommended: B6, B12, ascorbic acid.

With a progressive increase in the number of leukocytes and the size of the lymph nodes, primary restraining therapy is prescribed with the most convenient cytostatic drug chlorbutin (leukeran) in tablets of 2-5 mg 1-3 times a day.

When signs of decompensation of the process appear, cyclophosphamide (endoxan) is most effective intravenously or intramuscularly at the rate of 200 mg per day, for a course of treatment of 6-8 g.

With low efficiency of polychemotherapeutic programs, radiation therapy is used on the area of ​​enlarged lymph nodes and spleen, the total dose is 3000 rad.

In most cases, the treatment of chronic lymphocytic leukemia is carried out on an outpatient basis throughout the entire period of the disease, with the exception of infectious and autoimmune complications that require hospital treatment.

The life expectancy of patients with a benign form is an average of 5--9 years. Some patients live 25-30 years or more.

All patients with leukemia are recommended a rational regime of work and rest, nutrition with high content animal protein (up to 120 g), vitamins and fat restriction (up to 40 g). The diet should contain fresh vegetables, fruits, berries, fresh herbs.

Almost all leukemias are accompanied by anemia, so herbal medicine is recommended, rich in iron, ascorbic acid.

Use an infusion of wild rose hips and wild strawberries for 1/4-1/2 cup 2 times a day. A decoction of wild strawberry leaves is taken 1 glass a day.

Periwinkle pink is recommended, the herb contains more than 60 alkaloids. Of greatest interest are vinblastine, vincristine, leurosine, rosidine. Vinblastine (Rozevin) is an effective drug for maintaining remissions caused by chemotherapeutic agents. It is well tolerated by patients during long-term (2-3 years) maintenance therapy.

Vinblastine has some advantages over other cytostatics: it has more quick action(this is especially noticeable with high leukocytosis in patients with leukemia), does not have a pronounced inhibitory effect on erythropoiesis and thrombocytopoiesis. That allows sometimes to use it even with mild anemia and thrombocytopenia. It is characteristic that the inhibition of leukopoiesis caused by vinblastine is most often reversible and, with an appropriate dose reduction, can be restored within a week.

Rosevin is used for generalized forms of lymphogranulomatosis, lympho- and reticulosarcoma, chronic myelosis, especially with resistance to other chemotherapeutic drugs and radiation therapy. Enter intravenously 1 time per week, at a dose of 0.025--0.1 mg/kg.

use vitamin tea: rowan fruits - 25 g; rose hips - 25 g. Take 1 glass a day. Infusion of rose hips - 25 g, black currant berries - 25 g. Take 1/2 cup 3-4 times a day.

Apricot fruits contain a large amount of ascorbic acid, vitamins B, P, provitamin A. The fruits contain iron, silver, etc. 100 g of apricot affects the blood formation process in the same way as 40 mg of iron or 250 mg of fresh liver, which determines medicinal value of these fruits for people suffering from anemia.

American avocado, fruits are used in fresh, and also subjected to various processing. Salads, seasonings are prepared from the fruits, they are used as butter for sandwiches. Taken for the treatment and prevention of anemia.

Common cherry, used in raw, dried and canned form (jam, compotes). Cherry improves appetite, it is recommended as a tonic for anemia. Consume in the form of syrup, tincture, liqueur, wine, fruit water.

Common beetroot, various dishes are prepared, it is consumed in dried, salted, pickled and canned form. The combination of a large amount of vitamins with iron has a stimulating effect on hematopoiesis.

Black currant, the main advantage of the fruit is the low content of enzymes that destroy ascorbic acid, so they serve as a valuable source of vitamins. Recommended for hypochromic anemia.

Sweet cherries, fruits can be frozen and dried, compotes, preserves, jams are prepared from it. Effective in hypochromic anemia.

Mulberry is eaten in the form of syrups, compotes, dessert dishes and liqueurs. Used for hypochromic anemia.

Spinach, leaves contain proteins, sugars, ascorbic acid, vitamins B1, B2, P, K, E, D2, folic acid, carotene, mineral salts (iron, magnesium, potassium, phosphorus, sodium, calcium, iodine). Leaves are used for food, from which salads, mashed potatoes, sauces, and other dishes are prepared. Spinach leaves are especially useful for patients with hypochromic anemia.

In the diet of patients with anemia include vegetables, berries and fruits as carriers of "factors" of hematopoiesis. Iron and its salts contain potatoes, pumpkin, swede, onion, garlic, lettuce, dill, buckwheat, gooseberries, strawberries, grapes.

Potato, white cabbage, eggplant, zucchini, melon, pumpkin, onion, garlic, rosehip, sea buckthorn, blackberry, strawberry, viburnum, cranberry, hawthorn, gooseberry, lemon, orange, apricot, cherry, pear, ascorbic acid and B vitamins contain corn, etc.

You can use various medicinal plants including the following:

1. Collect buckwheat flowers and prepare an infusion: 1 cup per 1 liter of boiling water. Drink without restriction.

2. Prepare the collection: spotted orchid, two-leaved love, medicinal sweet clover, sowing buckwheat color - all 4 tbsp. l., lobed nightshade, field horsetail - 2 tbsp. l. For 2 liters of boiling water, take 6 tbsp. l. collection, take the first portion of 200 g in the morning, and then 100 g 6 times a day.

3. Collection: medicinal sweet clover, field horsetail, stinging nettle - all 3 tbsp. l. For 1 liter of boiling water, take 4-5 tbsp. l. collection. Take 100 g 4 times a day.

4. Drink juice from mallow roots, and children - juice from mallow fruits.

An operative blood transfusion is required for leukemia, since, first of all, cellular hyperplasia develops wherever blood vessels pass, as well as with concomitant changes in peripheral blood, in which a mutation occurs against the background of proliferative processes.

There are many severe manifestations of leukemia, including the detection of hemoblastosis as a tumor on the hematopoietic tissues of any life-support organs. A tumor that is detected in the bone marrow - and there is. Tumors that are found in lymphoid tissues are called lymphomas (hematosarcomas).

The disease of leukemia of this kind is divided into 3 groups, depending on the following reasons:

• infectious and viral pathogens;
• hereditary factors that do not depend on the will and behavior of the patient and are revealed only after many months of examination of his entire family;
• side effects of cytostatic drugs or antibiotics based on penicillin, which are used as a fight against oncological processes.

Transfusion process

Only highly qualified doctors are allowed to, because doing it at random, without training and a certain system, is strictly prohibited (and even criminally punishable!). Moreover, the process of blood transfusion in leukemia is accompanied by certain mandatory conditions that rest on the following: selection of the group and and. Otherwise, there will be no effect from the treatment, since many diseases can be cured by blood transfusion. various diseases, and in this particular case, only leukemia should be treated!

Effective treatment of various diseases by blood transfusion occurs due to the division into: erythrocytes, platelets, plasma or leukocytes. True, they use special medical equipment.

If we consider in detail the transfusion for leukemia, it is worth noting that erythrocytes are most often taken from the blood, and less often platelets. Naturally, not all blood is taken from the donor, for the patient, but only the components described above (depending on the nature of the leukemia), and the rest is poured back to the donor. This method treatment of leukemia is the most effective and safest.

When the plasma is returned to the donor, the blood is restored faster for the rest of its components and, as a result, more frequent transfusions can be performed than in the usual way.

It doesn’t matter if leukemia or another disease should be cured with the help of the latter, the same strict requirements are put forward.

The selection of a donor for a blood transfusion procedure for leukemia occurs as follows:

• Immediately before, the donor is obliged to present his medical card, which will indicate all the possible diseases that he had been ill with and the operations performed (if any). This is especially true for pregnant women or women after childbirth.
• Three days before blood transfusion, the use of alcoholic beverages and caffeinated drinks. It is also important to warn doctors about the fact of using drugs (if any) and their names. Leaving this factor aside, one can face the problem of the donor and the patient.
• Stop smoking four hours before the procedure.

Depending on the gender of the donor, doctors determine the frequency and possible number blood for transfusion. For example, women can donate blood every 2 months, and men - one month after the transfusion procedure, but not more than 500 ml.

No wonder people undergo scheduled medical examinations at intervals of at least 1 time per year. They take blood tests, do x-rays, check their eyesight, etc. Leukemia is determined by reconciling a blood test for and red blood cells. If their number is underestimated, then this is the first call for additional tests. It is also worth considering if nosebleeds occur (in this case, the patient may detect leukocytosis -).

Regardless of the stage at which leukemia was detected (better, of course, at an early stage), blood transfusions should be done as often as possible! The need for blood transfusion in leukemia is also explained by the fact that cancer cells rather quickly destroy healthy ones (the latter are not restored without blood transfusion). You also need to consider chemotherapy treatment, which also affects the destruction of healthy cells. Therefore, in complex treatment leukemia frequent transfusion blood is a vital necessity!

Side effects

What can happen to the human body after a blood transfusion? Allergic manifestations, fever, cloudy urine, chest pain and vomiting, cloudy urine... All this can happen to any patient, but it will not happen for a long time, as it is eliminated quite quickly.

But, unfortunately, no one is immune from the dangerous manifestations of the above described side effects. During the infusion (blood infusion), the patient's behavior should be carefully monitored and, in case of discomfort on his part, immediately stop this procedure.

Purpose of donated blood

At cancer regardless of the site of the lesion, transfusion is required in any case. But people also lose blood under other circumstances: during general malaise, during childbirth (in women). But in such cases, blood transfusion usually goes without complications.

For patients with leukemia, purpose donated blood- a prerequisite, without which it is impossible complete treatment, which leads to only one result - death!

Periodic blood transfusion for leukemia or transfusion, in medical terms, combined with a course of chemotherapy, can not only prolong life and make it better, but also turn the disease process into complete remission!

Note for a potential donor: if you are a volunteer to donate your own blood, then, firstly, you will provide invaluable assistance to potential patients who are in dire need of any help (in terms of the amount of blood needed) and, secondly, as scientists have proven, you will be able to strengthen your own immunity, since blood donation has a positive effect on the formation of new and healthy hematopoietic cells. You can carry out this procedure in a specialized medical center.

If you are in doubt whether you need to become a donor or not, then we hasten to reassure you: all potential donors undergo special tests and only if they do not find contraindications to this procedure are allowed to it!

A healthy person should have normal blood components such as platelets, erythrocytes and leukocytes. Complaints to the body occur precisely when they decrease. Even if you never want to donate your blood, it should be tested annually!

Normally, the weight of the donor should be more than 50 kg. Under this condition, he has the right to do the blood donation procedure once every two months, but not more than 500 ml at a time. If you meet all the criteria for your anthropological parameters and health status, then you have a huge chance to become useful to another person and, possibly, save someone's life!

Leukemia is terrible disease from which no one is immune. In short, it is blood cancer. Basically, cancer is a curse. modern life, because, at first, few people can understand that he is affected by this disease.

When this happens, then it may already be too late. But this does not mean that this disease should be feared like fire. No one ever knows who will be affected by the disease, but you can always find a way to either avoid it, or else, do it in such a way as to minimize the risk of disease.

Therefore, in this article we will consider in more detail what leukemia is, as well as what stages of leukemia are, what treatment can be, and many other things that need to be considered if this has already happened. In any case, you should not panic and succumb to fear. If the patient is determined to fight against the disease, there is a high probability that he will be able to emerge victorious from the terrible struggle.

What is leukemia? If to speak scientific terms, then leukemia is a tumor that forms on the hematopoietic tissue, moreover, the primary focus is located in the bone marrow. Those cells that form there are in the form of small tumors, after which they enter the peripheral blood, thereby obtaining the first signs of the disease.

Typically, leukemia can be roughly divided into acute and chronic. This division is not based on how long they last, or how suddenly a person fell ill, but on certain features of the cells that have undergone malignant transformation. It happens that immature cells undergo regeneration, which are called blasts, and then leukemia is called acute. But in the event that those cells that have already matured have changed in a person, then leukemia becomes chronic.

Acute leukemia

In order to understand whether leukemia is being treated or not, you need to understand its symptoms, and indeed how a person feels when he is exposed to the disease. Is it transmitted and what kind of care is needed? Now consider this type of blood leukemia, acute, what should be considered when it happens in people? When the stage of acute leukemia occurs, in this case, precursor cells are damaged, from which normal blood cells should have been formed in the future. But if a malignant degeneration occurs, then the cells simply stop in their development, which, of course, prevents them from functioning normally. In the twentieth century, a similar disease led to a huge number of deaths, and in just a few months in a row. Hence the disease is called acute.

Today, in most cases, it is possible to make a long-term remission of the disease occur, especially if you realize it at the beginning of development. Most often, a disease of this type occurs in young children of three or four years old, and elderly people from sixty to sixty-nine years old are also at risk, most often men are at risk here.

It is impossible to say what the causes of the disease are, but this determines the main number of risks that must be taken into account. Among these factors, one can catch heredity, also the presence of radiation, poor ecology, toxins, viruses, if drugs are constantly used for chemotherapy, or when a hematopoietic disease occurs.

So, for reasons unknown to science, a focus of undifferentiated cells may appear in the bone marrow, which rapidly divide, eventually simply displacing healthy cells. After that, the tumors begin to spread through all blood vessels, as a result of which metastases begin to form, both in the brain and in the spleen, liver, and other organs. And as science and medicine know, leukocytes are represented by several cell groups at once. All of them have a precursor cell, which is called myelopoiesis.

As for the sources of lymphocytes, they are precursor cells, which are called lymphopoiesis. And already, depending on the nature of the lesion, one of the types can develop: acute lymphocytic leukemia, or lymphoblastic leukemia; acute non-lymphoblastic leukemia. Moreover, if we talk about adult patients, then in most cases, they have exactly the second option. From all this, it is possible to divide the disease into stages. This initial stage when any symptoms of leukemia are simply absent. After it, an extended stage follows, when the first attack, relapses, remission, that is, what is characterized by full-fledged oppression of hematopoiesis, other complications, which most often can end lethal outcome for the patient.

In most cases (more than half of the examples), the disease begins and develops suddenly, while resembling acute illness. The patient begins to shiver, his head hurts a lot, the person feels overwhelmed, he needs good care, also not so rare, there are severe pains in the abdomen, nausea begins, followed by vomiting, the stool can become liquid. In ten percent of patients, the disease is able to show through bleeding from the nose, stomach, uterus.

It also happens that bruises, or a rash, are formed, the temperature rises. Joints can also hurt, bones break. But it also happens in such a way that the onset of the disease can be missed by both the patient and the doctor, who cannot identify the disease and make a diagnosis, because there are no obvious symptoms. And this happens often, in more than fifty percent of patients. The worst thing is that by this time there are already changes in the blood, which suggest the disease. During this extended period, defeat may occur various organs In addition, the symptoms themselves are very diverse.

Tumor intoxication can be accompanied by a feeling of fever, sweating increases, weakness is felt, weight can decrease very quickly. Lymph nodes may increase, the left hypochondrium may hurt, because the spleen changes in size. If metastases occur in distant organs, then the patient may experience severe back pain, headache. The stomach may hurt, diarrhea begins, itching on the skin, coughing and shortness of breath occur. If the patient has an anemic syndrome, then dizziness, weakness occur, a person can often faint. Extensive subcutaneous hemorrhages are also monitored, as well as blood from the nose, uterus, and intestines.

These signs in question are directly related to the suppression of hemorrhage. Sometimes nodes can appear right on the face that merge with each other and form the so-called "lion's face". All this looks very scary and unpleasant, you need to urgently take up treatment.

What to look out for, what symptoms may be visible

Leukemia disease can also be caused by the fact that if the patient had a sore throat, and it was very difficult to treat, or became recurrent, all this can turn into the above complications. Also pay attention if you have had inflamed gums, or rather gingivitis.

In order to be able to confirm the diagnosis, it is best to do a blood test, as well as a bone marrow puncture. Immediately after that, you need chemotherapy for leukemia, because the sooner you start, the better. All these actions will help achieve remission in most patients, up to eighty cases. Of these, up to thirty percent of patients are completely cured.

Chronic leukemia, its symptoms

In this regard, the cause of the disease may be that the precursor cell mutates, which is called myelopoiesis, and it is accompanied by the formation of a specific marker, or it is also called the “Philadelphia chromosome”. Leukemia is a blood cancer of this type most often found in young adults between twenty-five and forty-five years of age, and is most common in the male population.

Chronic myeloid leukemia is the most widespread disease cancer in adults. Over the course of one year, the disease can affect between three and eleven people out of one million. Patients can live after this for about five years, but if the disease is intercepted at an early stage, the chances of life become greater. And although at the very beginning the visible symptoms do not yet make themselves felt, there can still be significant changes in the blood.

In the advanced stage, signs such as tumor intoxication may appear, a person feels weak, sweating increases, weight decreases, bones and joints hurt, skin may change, abscesses and nodes appear.

If we talk about the terminal stage, then here all the germs of hematopoiesis are completely suppressed. The patient feels exhausted, the liver and spleen are greatly enlarged, there may be ulcers on the skin, there may be more in the blood uric acid. In order to carry out a leukemia prognosis, they begin to examine the blood, as well as the bone marrow, and a puncture of the spleen is also mandatory. After the diagnosis of leukemia is confirmed, chemotherapy is immediately started.

Which doctor is best to contact in case of illness

Be that as it may, but if it so happened that the disease struck you or a loved one, you need to act and act again. What kind of care is needed in this case, how can this disease be transmitted in general, is blood transfusion possible with leukemia, and so on.

In general, leukemia is a tumor disease and should be treated by a highly qualified oncohematologist. True, if the first symptoms appear, then you can first contact a hematologist initially. It happens that the disease may first manifest itself through profuse bleeding, then you need to immediately go to the ENT, gynecologist, surgeon. If the defeat occurs in oral cavity, then patients can go to the dentist, if the skin changes, then a dermatologist comes to the rescue. All these doctors are obliged to remember that all these symptoms can be a precursor to leukemia.

Most often, you can see a complication that develops in the nervous system, as well as in the lungs, but the patient should be consulted by a specialist neurologist, pulmonologist.

Is it possible to detect and prevent leukemia in time?

Despite the fact that leukemia is a very terrible disease, all the same, this does not mean that it cannot be prevented and overcome. The nursing process for leukemia can be very necessary, in order to defeat leukemia, the clinic is very important. Moreover, the onset of the disease can be detected, even if you just take a blood test.

For prevention, it is best to conduct a blood test every year. After all, it is no secret that today, so far, cancer is an invincible disease, however, if caught in the early stages, then deaths will be significantly less. In addition, in order to undergo a CBC, that is, a general blood test, you absolutely do not need to go to expensive clinics.

You need to do this once a year, check to see if you have tumors and so on. After all, do not forget that the sooner you realized it, the greater the chance of recovery. You can always get good advice, learn about nursing process with leukemia, how to proceed if you suspect a disease.

Acute leukemia is a systemic malignant disease of the hematopoietic tissue of the bone marrow, the morphological substrate of which is blast cells (cells at an early stage of development, immature), which affect the bone marrow, displacing normal cellular elements and spreading not only in the organs of hematopoiesis, but also in other organs and systems, including the central nervous system.

In acute leukemia, a large number of blast cells accumulate in the blood, which leads to inhibition of the normal hematopoiesis of all germs. Such signs are detected in the blood in more than 80% of cases.

There are two main forms of acute leukemia - acute lymphoblastic (ALL) and acute myeloid (AML, often called acute non-lymphoblastic leukemia). Each of these diseases is divided into many subspecies, differing in their morphological, immunological and genetic properties, as well as in approaches to their treatment. The selection of the optimal treatment program is possible only on the basis of an accurate diagnosis of the disease.

In 2002, 8,149 cases of leukemia were diagnosed in Russia. Of these, acute leukemias accounted for 3257 cases. ALL is the most common form acute leukemia in children - 85%, in adults it accounts for 20%). AML in children is 15%, in adults - 80% of the total number of acute leukemias.

Diagnosis of acute leukemia

Leukemia can be accompanied by many signs and symptoms, some of which are nonspecific. Please note that the following symptoms are more likely to occur with other diseases than with cancer.

Common symptoms of leukemia may include increased fatigue, weakness, weight loss, fever (fever), and loss of appetite. Most of the symptoms of acute leukemia are caused by a decrease in the number of red blood cells as a result of the replacement of normal bone marrow, which produces blood cells, with leukemic cells. As a result of this process, the number of normally functioning erythrocytes, leukocytes and platelets decreases in the patient.

Anemia (anemia) is the result of a decrease in the number of red blood cells. Anemia leads to shortness of breath, fatigue, and pale skin.

A decrease in the number of white blood cells increases the risk of developing infectious diseases. Although people with leukemia can have very high white blood cell counts, these cells are not normal and do not protect the body from infection.

A low platelet count can cause bruising, bleeding from the nose and gums.

Spread of leukemia outside the bone marrow to other organs or the central nervous system can cause various symptoms such as headache, weakness, convulsions, vomiting, gait and vision problems.

Some patients may complain of pain in the bones and joints due to their damage by leukemic cells.

Leukemia can lead to enlargement of the liver and spleen. If the lymph nodes are affected, they can be enlarged.

In patients with AML, gum disease leads to swollen, painful, and bleeding gums. Skin lesions are manifested by the presence of small multi-colored spots resembling a rash.

In T-cell type ALL, the thymus gland is often affected. Large vein (superior vena cava) carrying blood from the head and upper limbs to the heart, passes next to thymus. An enlarged thymus gland can compress the trachea, causing coughing, shortness of breath, and even suffocation. With compression of the superior vena cava, swelling of the face and upper limbs (syndrome of the superior vena cava) is possible. This can cut off the blood supply to the brain and be life-threatening. Patients with this syndrome should immediately begin treatment.

The presence of some of the above symptoms does not mean that the patient has leukemia. Therefore, additional studies are being carried out to clarify the diagnosis, and if leukemia is confirmed, its type.

Blood test

Quantity change various types blood cells and their appearance under a microscope may suggest leukemia. Most people with acute leukemia (ALL or AML), for example, have too many white blood cells and few red blood cells and platelets. In addition, many white blood cells are blast cells (a type of immature cell that does not normally circulate in the blood). These cells do not perform their function.

Bone Marrow Research

Using a thin needle, a small amount of bone marrow is taken for examination. This method is used to confirm the diagnosis of leukemia and evaluate the effectiveness of treatment.

Biopsy of a lymph node

In this procedure, the entire lymph node is removed and then examined.

spinal puncture

During this procedure, a thin needle is inserted in the lumbar region into the spinal canal to obtain a small amount of cerebrospinal fluid, which is studied to detect leukemic cells.

Laboratory research

Various special methods are used to diagnose and clarify the type of leukemia: cytochemistry, flow cytometry, immunocytochemistry, cytogenetics and molecular genetic studies. Specialists study bone marrow, lymph node tissue, blood, cerebrospinal fluid under a microscope. They evaluate the size and shape of the cells, as well as other characteristics of the cells to determine the type of leukemia, the degree of maturity of the cells. Most immature cells are infection-fighting blast cells that replace normal mature cells.

Other research methods

• X-rays are taken to detect tumor formations in chest cavity, damage to bones and joints.
• Computed tomography (CT) is special method x-ray examination, which allows you to examine the body from different angles. The method is used to detect lesions of the chest and abdominal cavities.
• Magnetic resonance imaging (MRI) uses strong magnets and radio waves to produce detailed images of the body. The method is especially justified for assessing the state of the brain and spinal cord.
• Ultrasound examination (ultrasound) allows you to distinguish between tumor formation and cysts, as well as the condition of the kidneys, liver and spleen, and lymph nodes.
• Scanning of the lymphatic and skeletal systems: In this method, a radioactive substance is injected into a vein and accumulates in the lymph nodes or bones. Allows differentiation between leukemic and inflammatory processes in lymph nodes and bones.

Principles of treatment

Patients with different subtypes of leukemia respond differently to treatment. The choice of therapy is based both on the specific subtype of leukemia and on certain characteristics of the disease, which are called prognostic signs. These features include the patient's age, white blood cell count, response to chemotherapy, and whether the patient has previously been treated for another tumor.

The main content of the treatment of acute leukemia is chemotherapy aimed at the destruction of leukemic (blast) cells in the patient's body. In addition to chemotherapy, a number of helper methods depending on the patient's condition: transfusion of blood components (erythrocytes, platelets), prevention of infectious complications, reduction of manifestations of intoxication, etc.

Some patients are given very high doses of chemotherapy to kill all bone marrow cells, followed by a bone marrow transplant or stem cell transplant.

Chemotherapy

The main way to treat acute leukemia is chemotherapy, mainly with cytostatic (stopping tumor growth) drugs. Different clinics use different treatment protocols (schemes).

The duration of treatment for acute leukemia is approximately the same regardless of the option - two years. Therapy is divided into a stationary stage - 6-8 months and outpatient treatment - up to 1.5-2 years.

Chemotherapy for acute lymphoblastic leukemia (ALL)

Induction

The goal of treatment at this stage is to destroy maximum number leukemic cells for minimum period time and achieving remission (no signs of the disease). At this stage, very intensive chemotherapy is used. This is a very difficult stage for the patient, both physically and mentally. In the first few weeks, almost constant infusion therapy is carried out - intravenous drip infusions. In addition to, in fact, drug therapy, the so-called “water load” is also given, firstly, so that the decay products of the tumor are more quickly washed out of the body, and secondly, because some drugs used in chemotherapy, for example, cyclophosphamide, can "plant" the kidneys if not accompanied by their infusion enough liquids. The state of remission is achieved when blast cells of the blood are not found in the body, neither in the peripheral blood, nor in the cerebrospinal fluid, nor in the bone marrow. Ideally, this condition occurs 2 weeks after the start of treatment, if this does not happen, the volume of chemotherapy increases.

Consolidation

Upon reaching remission, the treatment is not yet completed - further therapy is aimed at consolidating the results obtained. At this time, the patient is very often allowed to go home for a while. The regimen and diet should be followed at home. The patient needs to allocate a separate room, remove carpets and fresh flowers, and do not forget about daily wet cleaning. After a fixing course, some patients will undergo radiation therapy to an area of ​​the brain. Dose depends on age and protocol. During the period of radiation therapy, the patient needs to eat well, give up TV and work with a computer, spend at least 2 hours a day in the fresh air, sleep at least 8 hours, preferably during the daytime. It is advisable to eat more of the so-called antioxidants (green tea, Cahors, nuts, honey, B-carotene) in food. All these measures are necessary to reduce the toxic effect of radiation on the brain.

Supportive care

After the first two stages of chemotherapy, leukemia cells may still remain in the body. At this stage of treatment, low doses of chemotherapy drugs are prescribed. The patient is discharged for outpatient maintenance treatment, which is usually carried out for 1.5-2 years. That is, this is a treatment that is carried out at home, with periodic visits to a hematologist in a polyclinic to resolve current problems and conducting follow-up examinations or necessary courses of therapy.

Treatment of damage to the central nervous system (CNS)

Because ALL often spreads to the lining of the brain and spinal cord, people are given chemotherapy drugs into the spinal canal or radiation therapy to the brain.

Chemotherapy for acute myeloid leukemia (AML)

The treatment of AML consists of two phases: remission induction and post-remission therapy. During the first phase, most of the normal and leukemia cells in the bone marrow are destroyed. The duration of this phase is usually one week. During this period and over the next few weeks, the number of leukocytes will be very low and therefore measures against possible complications. If remission is not achieved as a result of weekly chemotherapy, then repeated courses treatment.

The goal of the second phase is to destroy the remaining leukemic cells. Treatment for a week is then followed by a period of bone marrow recovery (2-3 weeks), then chemotherapy courses continue several more times.

Bone marrow transplantation (BMT) and stem cell transplantation (SCT)

Bone marrow and stem cell transplantation is a procedure that allows the treatment of cancer with very high doses, primarily of chemotherapeutic agents, but sometimes of radiation. Since such treatment constantly destroys the bone marrow, it is in principle impossible, because the body loses the vital ability to produce blood cells. However, if healthy bone marrow (a substance that produces blood) or stem cells (precursor cells in the bone marrow that develop into blood cells) is reintroduced into the body after treatment, bone marrow replacement and restoration of its ability to form blood is possible. Therefore, bone marrow and stem cell transplants allow high-dose therapy to cure a particular cancer when lower doses fail.

There are three types of transplantation: autologous, involving the use of the patient's own bone marrow or stem cells, allogeneic from related donors, and from unrelated donors.

Bone marrow transplantation can be called classical. The purpose of bone marrow removal is to obtain the progenitor cells (stem cells) contained in the marrow, which then develop into various components of the blood during development. Prior to any intensive treatment, bone marrow is removed from the patient's or donor's femurs, then frozen and stored until use. This is called extraction. Later, after chemotherapy is completed, with or without radiotherapy, the bone marrow is injected back into the body by drip, similar to a blood transfusion. The brain circulates through the body with the bloodstream and eventually settles in the cavities of the bones, where it begins to grow and the process of hematopoiesis resumes.

Substances known as growth factors have been created. They are proteins that stimulate the production of large numbers of progenitor cells (stem cells) that enter the bloodstream from the bone marrow. The use of growth factors means that it is no longer always necessary to extract the marrow and reinsert it. It is enough to get only stem cells from the blood. This has many benefits. By using this method More stem cells can be removed and reintroduced, resulting in more fast recovery number of cells in the blood and therefore reduces the time that a transplant patient is at risk of infection. In addition, it is easier to obtain stem cells from blood than bone marrow from bones, eliminating the need for anesthesia.

Stem cells are usually taken after a course of chemotherapy (either during the initial treatment or a single dose is skipped for this purpose). In chemotherapy, the drugs administered first cause a decrease in the number of cells in the blood. However, after a few days, their number increases and the restoration of hematopoiesis begins. Doctors use this moment to administer growth factors to get maximum effect and ensure that it enters the bloodstream as much as possible more stem cells.

The transplantation process consists of four stages.

1. The initial treatment of cancer with chemotherapy and/or radiotherapy with the goal of minimizing the cancer as much as possible. Ideally, transplant recipients should be in remission (i.e. cancer-free), as this is the most likely that intensive treatment will be effective. However, it can also be successful in the presence of a small number of cancer cells.
2. Bone marrow or stem cells are obtained from a patient or a donor under general anesthesia. About 1 liter of bone marrow is taken from a number of points above the femurs and sometimes the sternum with a syringe. This usually requires a short stay in the hospital, and after the procedure, the patient may have disease state and feeling weak, so he needs pain medication for a few days. Stem cells are obtained by hemophoresis, which is carried out at a time when the number of stem cells released into the bloodstream is highest, which is observed after chemotherapy and the introduction of a growth factor, as indicated earlier. During this process, blood is taken from one arm and placed in a centrifuge to separate the stem cells. The remaining blood is then injected back into the other arm. The whole procedure lasts about 3-4 hours and is absolutely painless.
3. Treatment. The treatment is carried out in a hospital, usually lasts 4-5 days, and involves the administration of very high doses of chemotherapy drugs and sometimes whole-body radiation. During the stay in the hospital, the patient is usually placed in a separate room due to hypersensitivity to infection. Treatment with anti-cancer drugs is usually done with a Hichman tube (central tube) that is inserted under anesthesia. This tube can also be used to infuse fluids, draw blood samples, and inject bone marrow or stem cells, as provided in step 4. Antiemetics and possibly sedatives are given to prevent nausea and vomiting, and may also be sedated so that they do not feel much discomfort. .
4. Reintroduction of bone marrow or stem cells. Bone marrow or stem cells are injected backwards through a central tube, similar to a blood transfusion, and are delivered to the bones in the bloodstream. However, normal hematopoiesis is restored only after a few weeks, during which the patient is carefully monitored. A low white blood cell count makes patients extremely vulnerable to infections, so they are regularly given antibiotics. Even those bacteria present in the skin and intestines that have a beneficial effect on healthy people may cause harm and infection in debilitated patients. Particular care must be taken to ensure that the infection is not introduced from the outside, for which they limit visits to the patient.

Forecast

The prognosis for children with acute lymphocytic leukemia is good: 95% or more go into complete remission. In 70-80% of patients, there are no manifestations of the disease for 5 years, they are considered cured. If a relapse occurs, in most cases a second complete remission can be achieved. Patients with a second remission are candidates for bone marrow transplantation with a probability of long-term survival in 35-65% of cases.

The prognosis for patients with acute myeloid leukemia is relatively unfavorable. In 75% of patients receiving adequate treatment using modern chemotherapeutic regimens, complete remission is achieved, 25% of patients die (the duration of remission is 12-18 months). Patients younger than 30 years after achieving the first complete remission, bone marrow transplantation can be performed. In 50% of young patients who have undergone transplantation, a long-term remission develops.

What we used to think of as "blood cancer" is called "hemoblastosis" by oncologists. In essence, “hemoblastosis” is not one disease, but a whole group of tumor diseases of the hematopoietic tissue. In the event that cancer cells occupy the bone marrow (the place where blood cells form and mature), hemoblastoses are called leukemias. If the tumor cells multiply outside the bone marrow, we are talking about hematosarcomas.

What is leukemia?

Leukemias (leukemias) are also not one disease, but several. All of them are characterized by the transformation of a certain type of hematopoietic cells into malignant ones. At the same time, cancer cells begin to multiply indefatigably and replace normal cells in the bone marrow and blood.

Depending on which blood cells have become cancerous, there are several types of leukemia. For example, lymphocytic leukemia is a defect in lymphocytes, myeloid leukemia is a violation of the normal maturation of granulocytic leukocytes.

All leukemias are divided into acute and chronic. Acute leukemia is caused by the uncontrolled growth of young (immature) blood cells. In chronic leukemia, the number of more mature cells sharply increases in the blood, lymph nodes, spleen and liver. Acute leukemias are much more severe than chronic ones and require immediate treatment.

Leukemia is not the most common cancer. According to the American medical statistics only 25 out of 100,000 people fall ill with it every year. Scientists have noticed that leukemia most often occurs in children (3-4 years old) and in the elderly (60-69 years old) people.

Causes of leukemia (blood cancer)

Modern medicine has not completely figured out the cause of leukemia (blood cancer). But any cause of leukemia leads to a malfunction immune system. For a person to develop leukemia, it is enough for a single hematopoietic cell to mutate into cancer. It begins to divide rapidly and gives rise to a clone of tumor cells. Viable, rapidly dividing cancer cells gradually take the place of normal cells and leukemia develops.

Possible causes of mutations in the chromosomes of normal cells are as follows:

1. Exposure to ionizing radiation. So in Japan, after atomic explosions, the number of patients with acute leukemia increased several times. Moreover, those people who were at a distance of 1.5 km from the epicenter fell ill 45 times more often than those who were outside this zone.
2. Carcinogens. These include some medications(butadione, chloramphenicol, cytostatics (antineoplastic)), as well as some chemical substances(pesticides; benzene; products of petroleum distillation, which are part of varnishes and paints).
3. Heredity. This mainly refers to chronic leukemia, but in families where there were patients with acute leukemia, the risk of getting sick increases by 3-4 times. It is believed that it is not the disease that is inherited, but the tendency of cells to mutate.
4. Viruses. There is an assumption that there are special types of viruses that, embedding in human DNA, can transform a normal blood cell into a malignant one.
5. The occurrence of leukemia to a certain extent depends on the race of a person and the geographical area of ​​\u200b\u200bits residence.

How to recognize leukemia (blood cancer)?

It is unlikely that you will be able to diagnose yourself with leukemia, but it is necessary to pay attention to a change in well-being. Keep in mind that the symptoms of acute leukemia are accompanied by high fever, weakness, dizziness, pain in the limbs, and the development of heavy bleeding. Various infectious complications can join this disease: ulcerative stomatitis, necrotic tonsillitis. There may also be an increase in lymph nodes, liver and spleen.

The symptoms of chronic leukemia are characterized by increased fatigue, weakness, poor appetite, weight loss. The spleen and liver are enlarged.

In the late stage of leukemia (blood cancer) there are infectious complications, a tendency to thrombosis.

Leukemia is systemic disease, in which by the time of diagnosis there is a lesion of the bone marrow and other organs, therefore, with leukemia, the stage is not determined. The classification of the stages of acute leukemia pursues a purely practical goals: definition therapeutic tactics and forecast evaluation.

Diagnosis of leukemia (blood cancer)

Diagnosis of leukemia (blood cancer) is carried out by an oncologist based on a general blood test, biochemical analysis blood. It is also necessary to conduct bone marrow studies (sternal puncture, trepanobiopsy).

Leukemia (blood cancer) treatment

For the treatment of acute leukemia, a combination of several anticancer drugs and large doses of glucocorticoid hormones. In some cases, a bone marrow transplant is possible. Supportive measures are extremely important - transfusion of blood components and fast treatment associated infection.

In chronic leukemia, so-called antimetabolites are currently used - drugs that inhibit the growth of malignant cells. In addition, they sometimes use radiation therapy or the introduction of radioactive substances such as radioactive phosphorus.

The doctor chooses the method of treating blood cancer depending on the form and stage of leukemia. The patient's condition is monitored by blood tests and bone marrow studies. You will have to be treated for leukemia for the rest of your life.

After completion of the treatment of acute leukemia, dynamic monitoring in the clinic is necessary. This observation is very important, as it allows the doctor to observe possible relapse(return) of leukemia, as well as for side effects therapy. It is important to tell your doctor immediately if you develop symptoms.

Usually, recurrence of acute leukemia, if it occurs, occurs during treatment or shortly after it ends. Relapse of leukemia develops very rarely after remission, the duration of which exceeds five years.