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ALL- Acute Lymphocytic Leukemia

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what is ALL Acute Lymphocytic Leukemia

ALL or Acute Lymphocytic Leukemia, is a malignant disease affecting the bone marrow, circulating blood, lymph nodes, spleen, liver, and just about all other organs. It is a hematologic malignant disease characterized by large numbers of immature cells, majority of which are lymphoblasts. Because of the increased amounts of these cells, normal circulating cells are greatly reduced leading to secondary anemia, malnutrition, and a host of other associated conditions. The majority of cases in the United States occur in children.

This disease has a higher rate of occurrence in persons with downs syndrome and in the children of leukemia patients. Often siblings will also develop this disease, although the exact reason is unknown, it is thought to be that the genetic similarities are close enough to be a contributing factor. 

Onset is rather fast, thus the term ACUTE, often manifesting by the patients experiencing pyrexia, pallor, anorexia, fatigue, anemia, hemorrhage, bone pain, splenomegaly, and frequent recurring infections. In order to understand what these patient experience, I will list each of the symptoms with the definition as indicated by mosbys medical dictionary ( 2002 edition ) as it relates to this disease.

PYREXIA- Also known as fever, an elevation in body temperature above the circadian range as the result of an increase in the body core temperature of greater than 37 c or 98.6 f. Fever is caused by an imbalance between the elimination and the production of heat.

PALLOR- An un-natural paleness or absence of color in the skin. This is often caused by the redirection of blood away from the surface of the skin.

ANOREXIA- Lack or loss of appetite resulting in the inability to eat.

FATIGUE- An overwhelming sense of exhaustion and decreased capacity for physical and mental work regardless of levels of adequate sleep.

ANEMIA- A decrease in the hemoglobin in the blood  to levels below the normal range of 12-16 g/dl. Anemia is caused by the decrease in red blood cell production, and an increase in the red blood cell destruction, or blood loss.

HEMORRHAGE- The loss of a large amount of blood in a short amount of time. This loss can be either internal or external. May be of an venous, arterial, or capillary source.

BONE PAIN- Pain within the bone.

SPLENOMEGALY- An abnormal enlargement of the spleen. Often associated with portal hypertension, hemolytic anemia, malaria, and Niemann-Pick disease.

FREQUENT RECURRING INFECTIONS- Infections that often to the same area or affects the same organ or system.

Diagnosis of this disease is based off of blood samples and marrow samples. The blood is obtained through the standard phlebotomy techniques, while the marrow is obtained through marrow aspiration. Marrow aspiration is utilized to confirm a suspected case. After the skin in suitably numbed, a small incision is made and a small boring tool is inserted to the bone. The bone of choice is either the sternum ( breast bone ) or the iliac crest ( the hip bone. these are often the richest sources of marrow. A small section is bored out and the physician aspirates or sucks out the marrow. although the skin and muscle is numbed, it is not possible to numb the bone. As such it is a very painful procedure to endure.

The pathologist takes the samples and prepares slides for microscopic examination. What the pathologist is looking for are specific types of cells. Specifically B-cells and T-cells. Often there are what is known as null cells present. null cells are cells that exhibit neither B or T cell characteristics. B and T cells respond very poorly to conventional cancer treatments. B-cells are cells are a type of lymphocyte that originates in the bone marrow, as a precursor to plasma cells, it is responsible for the bodies immune response. T-cells are small circulating lymphocytes that are produced in the bone marrow and mature in the thymus gland. T-cells most often have the responsibility of mediating cellular immune responses. there are several types of T-cells, the helper T-cell which assists B-cells, and suppressor T-cells, which inhibit the ability of B-cells to help fight infections.

Treatment of ALL includes intensive combination chemo therapies, therapy for secondary infections, and hyperuricemia. Irradiation is uses in conjunction with chemotherapy, as well as intrathecal methotrexate. all treatments have significant side effects which require additional medication to combat these related issues. Some of the medications used include the chemotherapy drugs, analgesics, anti emetics, stool softeners, antidepressants, antibiotics, antifungal, specialized tooth paste and mouthwash. Lets look at a few examples. Methotrexate is a drug used for cancers, it acts by inhibiting malignant cell growth. Analgesics, such as hydromorphone ( dilaudid ) which is a potent narcotic. Acetaminophen, aka Tylenol, this is used for fevers and pain. Reglan is a medication used that suppress the bodies sensation of nausea and helps relieve vomiting. Colace, aka Docusate sodium is used to loosen bowels, with the use of narcotics the body tends to dry out some, so the gut holds onto as much water as it can leading to constipation. Loperimide is used to slow down or inhibit loose stools, which is common with methotrexate. Megestrol or also known as megace is often used to combat anorexia, as common side effects of the chemo drugs depresses hunger. Antidepressants such as effexor is often used because the patient very frequently develops clinical depression. Antibiotics are also used heavily due to the high incidence of secondary infection throughout the body. a patient undergoing irradiation and chemo will also often develop thrush, which is a fungal infection of the mouth so anti fungal mouth rinses are used.

Lets look at a few of the associated side effects of the treatments of ALL and other cancers. Anorexia, constipation, loose stools, burns, thrush, bleeding gums, tooth loss, alopecia, body odor, toe and finger nail loss, brittle nails, pain, headache, fever, depression, and infections. One of the most concerning issues of these patients surprisingly is body odor. cancer patients often have a strong sick sweet like aroma. these patients are acutely aware of this,and due to this condition frequently refuse to leave there homes, except for treatments or doctor appointments. They are not being anti social, but rather feel they are being considerate to others.

Many of you know or have family members with this disease and are aware of the difficulties they face. we are all responsible to educate others as to what these patients are experiencing.

1 comment

Abdel-moniem El-Shorbagy
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Posted on Apr 3, 2011

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John Ferry

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