1. Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia
Arifin Dwi Atmaja, S. Kep.
Doc. Arifin Dwi Atmaja, S. Kep.

2. Doc. Arifin Dwi Atmaja, S. Kep.
Introduction
Leukemia: 25-35% Childhood Cancer
ALL:
Malignant Disease
Progressive Infiltration of Bone Marrow and Lymphatic Organs by immature lymphoid cell lymphoblasts
Doc. Arifin Dwi Atmaja, S. Kep.

3. Etiology and Epidemiology
Radiation
Chemicals
Drugs
Viruses
Genetic Abnormalities
Doc. Arifin Dwi Atmaja, S. Kep.

4. Doc. Arifin Dwi Atmaja, S. Kep.
Incidence
3 per children
Peak: 2-6 years
Sardjito ( ) Leukemia= 48%
Indonesia problems:
Registration, Protocol, Specific diagnosis, Cost (drugs and suportive)
Doc. Arifin Dwi Atmaja, S. Kep.

5. Doc. Arifin Dwi Atmaja, S. Kep.
Prognosis
Poorer Countries: prognosis poor
Many patients without any treatment
Doc. Arifin Dwi Atmaja, S. Kep.

6. Doc. Arifin Dwi Atmaja, S. Kep.
Clinical Signs
Symptoms:
Malaise, Fatigue
Bleeding, bruising
Fever
Bone pain
Lymphadenophaty (80%
Splenomegali and hepatomegali (70-75%)
Enlargement of the testes
CNS: Intracranial pressure > and cranial nerve palsies)
Doc. Arifin Dwi Atmaja, S. Kep.

7. Laboratory and Radiology
Peripheral blood: anemia, trombocytopenia, Neutropenia
Bone marrow Aspirate: >25% leukemia lymphoblasts
Radiographic: Mediastinal mass (5-10%)
Doc. Arifin Dwi Atmaja, S. Kep.

8. Doc. Arifin Dwi Atmaja, S. Kep.
FAB Classification
Morphological classification:
French-American-British (FAB):
L1: 80%, L3:< 2%, L2: the Remainder
L1: Higher remission
Prolonged survival than L2 and L3
L3: The worst prognosis
Doc. Arifin Dwi Atmaja, S. Kep.

9. Doc. Arifin Dwi Atmaja, S. Kep.
Prognostic Factors
WBC, Hb, Trombosit
Age
Cytogenetic
Organomegaly
FAB Morphology
Immunophenotype
Mediastinum mass, Sex, CNS disease
Doc. Arifin Dwi Atmaja, S. Kep.

10. ALL Management in childhood
Four components
Remission induction
Intensification
CNS treatment
Continuation
The purpose: eradicate leukemic cells
Doc. Arifin Dwi Atmaja, S. Kep.

11. Doc. Arifin Dwi Atmaja, S. Kep.
Remission induction
Regimen:
Vincrisrine (VCR)
Dexzamethasone
Methotrexate (MTX) intratekal
Daunorobicin (Dauno) hanya untuk resti
L-asparaginase
Doc. Arifin Dwi Atmaja, S. Kep.

12. Doc. Arifin Dwi Atmaja, S. Kep.
Problems:
Difficult diagnosis
Education/ information
No cost, no delay
Complications/ failure
Doc. Arifin Dwi Atmaja, S. Kep.

13. Intensification/ consolidation
Combination:
MTx iv, 6- MP and L-asp
Problems: cost, complications, isolation room
Doc. Arifin Dwi Atmaja, S. Kep.

14. Doc. Arifin Dwi Atmaja, S. Kep.
Supportive care
Hemorrhage
Infection
Leukemia patient’s association
Doc. Arifin Dwi Atmaja, S. Kep.

15. Doc. Arifin Dwi Atmaja, S. Kep.
Terima kasih
Doc. Arifin Dwi Atmaja, S. Kep.