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Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia

Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia. 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. Etiology and Epidemiology.

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Asuhan Keperawatan Pasien Anak dengan Acut Lymphoblastic Leukemia

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

  2. 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. Incidence • 3 per 100.000 children • Peak: 2-6 years • Sardjito (1992-1998) Leukemia= 48% • Indonesia problems: • Registration, Protocol, Specific diagnosis, Cost (drugs and suportive) Doc. Arifin Dwi Atmaja, S. Kep.

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

  6. 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. 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. Prognostic Factors • WBC, Hb, Trombosit • Age • Cytogenetic • Age • 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. Remission induction • Regimen: • Vincrisrine (VCR) • Dexzamethasone • Methotrexate (MTX) intratekal • Daunorobicin (Dauno) hanya untuk resti • L-asparaginase Doc. Arifin Dwi Atmaja, S. Kep.

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

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

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