Leukemia

CHAPTER I

INDRODUCTION

1.      BACKGROUND

White blood cells have a variety of cell nucleus, so it can be distinguished by its cell nucleus and translucent colors. White blood cells formed in the bone marrow of the cell-sei going. White blood cell function is as killing and eating germs or bacteria that enter the body tissues RES (reticulo endothelial system) and as a carrier or carrying of fatty substances from the intestinal wall through the spleen continues into a vein. (Handayani, 2008: 6-7).

White blood cells proliferate too much and too early can cause a disease called leukemia. Leukemia is a cancer of white blood cells.

Leukemia is a group of diseases characterized by the accumulation of malignant leukocytes in bone marrow and blood. These abnormal cells causes the onset of symptoms due to bone marrow failure (anemia, neutropenia, thrombocytopenia) and infiltration of organs (eg liver, spleen, lymph nodes, meninges, brain, skin, or testes). (Hoffbrand et al, 2002: 150).

Leukemia is classified into two types of acute leukemia and chronic leukemia. Leukemia is very dangerous and can cause death. Treatment can be done partly by undergoing chemotherapy and to perform chemotherapy also requires no small cost.

2.      PROBLEMS

There are some questions of problems that will be discussed in the paper. They are as follows :

ü  What are the of causes Leukemia?

ü  What are the symptoms, therapy, the treatment and medication?

CHAPTER II
THEORETICAL REVIEW

2. 2.1 Leukemia

Leukemia in Greek leukos "white", aima "blood"), or more commonly known as blood cancer is a disease in cancer classification (medical term: neoplasm) in the blood or bone marrow characterized by the multiplication is not normal or malignant transformation of blood-forming cells in bone marrow and lymphoid tissues, generally occurs in leukocytes (white blood cells). Normal cells in the bone marrow is replaced by abnormal cells or abnormal. These abnormal cells out of the marrow and can be found in the peripheral blood or peripheral blood. Hematopoiesis or leukemia cells affect the formation of normal blood cells and immune sufferers.

The word leukemia means white blood, because the patients found many white blood cells before therapy was given. White blood cells are cells that looked much younger, for example promielosit. The amount of this rise can disrupt the normal function of other cells (http://id.wikipedia.org/wiki/Leukemia, Accessed on October 23, 2011)

Leukemia is a group of diseases characterized by the accumulation of malignant leukocytes in bone marrow and blood. These abnormal cells causes the onset of symptoms due to bone marrow failure (anemia, neutropenia, thrombocytopenia) and infiltration of organs (eg liver, spleen, lymph nodes, meninges, brain, skin, or testes) (Hoffbrand et al, 2002: 150).

Leukemia is a disease characterized by premature excessive proliferation of white blood cells. Leukemia can also be defined as haematological malignancies due to interference with the process of neoplastic differentiation at various levels of hematopoietic stem cells (Handayani and Haribowo, 2008: 87).

2.2 Classification of Leukemia

            There are two main classifikasi of Leukemia according  to Handayani and Haribowo (2008 : 89).

They are as follows:

ü  Acute Leukemia

ü  Chronic Leukemia

2.2.1        Acute Leukemia

Acute leukemia is the abnormal proliferation of leukocytes cells, malignant, often accompanied by other forms of leukocytes than normal, the numbers are exaggerated, and can cause anemia, thrombocytopenia, and ends with death.

Manifestations of acute leukemia is the result of complications that occur in hematopoietic neoplasms in general. But each has a characteristic of acute leukemia respectively. Broadly speaking, acute leukemia has 3 main signs are: The number of cells in the periphery is very high, thus causing the tissue infiltration or leukostasis. Replacement of normal bone marrow elements which can produce complications as a result of anemia, thrombocytopenia, and leukopenia.

Acute leukemia can be diagnosed through several tools, such as:

ü  Examination of morphology: peripheral blood, bone marrow aspiration, bone marrow biopsy.

ü  Cytochemical staining.

ü  Immunofenotipe.

ü  Cytogenetics.

ü  Molecular diagnostic

2.2.2        Chronic Leukemia

Chronic myeloid leukemia is a myeloproliferative disease characterized by excessive production of granulocytes series of relatively mature, with symptoms that occur slowly and leukemianyaberasal cells of the myeloid stem cell transformation.

Chronic leukemia early disease leukemia cells can still do some work as a normal white blood cells. People who suffer from chronic leukemia may not have any symptoms at first. Doctors often find chronic leukemia during a routine exam before any symptoms. Slowly, chronic leukemia worsens as the number of leukemia cells in the blood increases. Typical symptoms that arise, such as swollen lymph nodes or infection. When symptoms appear, they are usually mild at first and gradually worsened.

CHAPTER III
DISCUSSION

3.1 What are the of causes Leukemia

Although the majority of patient with leukemia factors cause not be indentifiend, but there are several factors that are proven to cause leukemia, ie genetic factors, sinar radioactive and viruses.

According to Handayani and Haribowo (2008 : 88—89), there are causes of Leukemia. They are as follow:

a.       Genetic factors

Abnormalities in chromosome 21 can cause acute leukemia. The incidence of acute leukemia is also elevated in patients with aneuloidi congenital abnormalities, such as congenital agranulocytosis, Ellis van Greveld syndrome, celiac disease, Bloom syndrome, Fanconi anemia, klenefelter syndrome and trisomy D syndrome.

b.      Radioactive Rays

Radioactive rays are the most obvious external factors can cause leukemia in animals and in humans. Recently demonstrated that patients treated with radioakif rays will suffer from leukemia at 6% of new clients and occurs after 5 years.

c.       virus
Some of the specific virus has been proven to cause leukemia in animals but until now has not been proven that cause leukemia in humans is a virus. Some research results support the theory as pernyebab leukemia virus reverse transcriptase is an enzyme found in human blood.

3.2 Sign and Symtoms of Leukemia

Leukemia Symptoms are generally caused differ among patients, however, can generally be described as follows:

1.      Anemia

Patients would appear tired, pale and breathing fast (below normal red blood cells causing less oxigen in the body, resulting in the patient breathes faster to compensate for the fulfillment of oxigen deficiency in the body).

2.      Hemorrhage

When the platelets (blood clotting cells) are not reproduced with reasonable because it is dominated by white blood cells, then the patient will experience bleeding skin tissue (number of red wiggler width / minor tissue            skin).

3.      Esophageal Infections

White blood cells act as a protective immunity, especially against infectious diseases. In Patients with leukemia, white blood cells that diterbentuk is not normal (abnormal) so it does not function properly. As a result the body of the patient vulnerable to infection virus / bacteria, even by itself would reveal complaints of fever, white discharge from the nose (runny) and cough.

4.      Bone pain and joints

This is caused as a result of bone marrow (bone marrow) by pressing solid white blood cells.

5.      Stomach Pain

Abdominal pain is also one indication of the symptoms of leukemia, in which the leukemia cells may collect in the kidneys, liver and bile that causes enlargement of these organs and timbulah pain. Abdominal pain can affect appetite loss of leukemia patients.

6.      Swollen glands lympa

Patients likely to have swollen glands lympa, whether it is under the arms, neck, chest and more. Gland lympa duty filter the blood, leukemia cells may collect here and cause swelling.

7.      Difficulty breathing (dyspnea)

The patient may show symptoms of difficulty breathing and chest pain, if this happens then it should immediately get medical help (http://www.infopenyakit.com/2008/01/penyakit-leukemia-kanker-darah.html, Accessed on October 23, 2011)

3.3 Therapy for Leukemia, Treatment and Medication

Chemotherapy

Most people with leukemia undergoing chemotherapy, to kill leukemia cells. Depending on the type of leukemia, he could receive a single drug or a combination of two or more drugs.

Chemotherapy can be given in several different ways, which include:

* Through the mouth

* By injection into a blood vessel

* Through the catheter

* Direct injection into the cerebrospinal fluid

* Injection into the spine or Ommaya reservoir

Catheter

When chemotherapy is given in this way, a thin flexible tube placed in a large vein, often on the upper chest. A permanent catheter is often useful for people who need many IV treatments. The paramedics will inject the drug into the catheter, rather than directly into a vein. This method avoids many injections, which can injure blood vessels and skin and less comfortable in the skin.

Cerebrospinal fluid injection into the

If the pathologist finds leukemia cells in the fluid that fills the spaces in and around the brain and spinal cord, the doctor may order intrathecal chemotherapy. The doctor will then inject the drugs directly into the cerebrospinal fluid. This method is used because drugs given by intravenous injection or by mouth often do not reach cells in the brain and spinal cord.

Radiotherapy

Radiotherapy uses high energy rays to kill leukemia cells. The people receiving radiotherapy at hospital or clinic. Some people receive radiation from a large machine devoted to the pancreas, brain, or other parts of the body where leukemia cells accumulate. Any type of therapy that lasted for 5 days / week for several weeks. Other people may receive radiation directed to the whole body. Radiation is usually given once or twice a day for several days, usually before stem cell transplantation.

Side effects from radiation therapy depend mainly on the radiation dose and body parts are exposed. For example, radiation to your abdomen can cause nausea, vomiting, and diarrhea. In addition, your skin in the area being treated can become red, dry, and soft. You can also lose hair in the exposed area. You might be very tired during radiation therapy, especially a few weeks after treatment. Rest is very important, but doctors usually advise patients to try to stay active as much as possible.

Stem Cell Transplantation

Some people with leukemia received a stem cell transplant. Stem cell transplant allows you to receive chemotherapy, radiation or both to destroy leukemia cells. Once you receive high-dose chemotherapy, radiation therapy, or both, you will receive the stem cells are healthy through large blood vessels. New blood cells develop from the transplanted stem cells. New blood cells to replace that destroyed by the treatment.

Stem cell transplants performed in the hospital. Stem cells can come from you, from your identical twin, or from someone who donated their stem cells for your stem cells derived from several sources: from blood or from bone marrow (bone marrow transplant). Another source of stem cells is umbilical cord blood. Cord blood taken from newborns and stored in a freezer.

After a stem cell transplant, you may stay in the hospital for several weeks or months. You will be at high risk of infection and bleeding due to large doses of chemotherapy or radiation you receive. It takes time for the cell-transplanted stem cells to begin producing healthy blood cells. Another problem with stem cell transplantation is the occurrence of graft-versus-host (GVHD) can occur in people who receive donated stem cells. In GVHD, the white blood cells donated by patients react to normal tissues. Most often, liver, skin, or digestive tract is affected. GVHD can be mild or very severe. This can happen at any time after the transplant, even years later. Steroids or other drugs can help.

Biological Therapy: Interferon

Some people with leukemia are advised to have biological therapy. Biological therapy for leukemia is a therapy by increasing the body's immunity against disease. One type of biological therapy is a substance called a monoclonal antibody. This is given via intravenous infusion. This substance binds to the leukemia cells. One type of monoclonal antibodies carrying toxins that kill leukemia cells. Another type helps the immune system destroy leukemia cells.

For some people with CML given biological therapy with the drug Interferon. Interferon is a set of proteins released by cells infected with the virus. They help normal cells to make antiviral proteins. Interferon also helps the body to reduce the proliferation (growth and reproduction) leukemia cells, while strengthening the immune response.

Interferon-alpha (INFA) is a type of interferon that is often used to treat leukemia. INFA is usually offered to patients with newly diagnosed, are not candidates for stem cell transplantation. Side effects that may arise include: fever, chills, muscle and bone pain, headache, fatigue, nausea, vomiting, and flu-like complaints when starting treatment. Such symptoms usually last for 1-2 weeks. Side effects usually improve after therapy with INFA completed.

Argeted Therapy

People with CML and ALL may receive a drug called Targeted Therapy. Imatinib (Gleevec) is the first approved targeted therapy for CML. In the case of resistance to Imatinib, especially in advanced stages of CML cases, drugs such as Tasigna (second-generation Gleevec), AMN-107 or BMS 354 825 promising hope. Currently except for Tasigna, these drugs still in clinical trials.

Targeted therapy uses drugs that inhibit the growth of leukemia cells. For example, targeted therapies may block the mechanism of abnormal proteins that stimulate the growth of leukemia cells. Side effects of Targeted therapies, such as: swelling, bloating, weight gain and sudden. Targeted therapy can also cause anemia, nausea, vomiting, diarrhea, muscle cramps, or rash. Discuss with your doctor if you catch the symptoms of side effects (http://www.cancerhelps.com/pengobatan-kanker-darah.htm, Accessed on October 23, 20011)

CHAPTER IV
CONCLUSION AND SUGGESTOIN

4.1 CONCLUSION

After reading and Understanding of “Leukemia” from a paper that has been written above, it can be conclusion that:

Leukemia is a group of diseases characterized by the accumulation of malignant leukocytes in bone marrow and blood. These abnormal cells causes the onset of symptoms due to bone marrow failure (anemia, neutropenia, thrombocytopenia) and infiltration of organs (eg liver, spleen, lymph nodes, meninges, brain, skin, or testes).

4.2 SUGGESTION

To prevent the occurrence of leukemia a person can consume mangosteen and strawberries, strawberries in terkandungan two kinds of substances called amine strawberry and acid tanat which has the function to curb the growth of malignant tumors and can make healthy lifestyle.

BIBLIOGRAPH

Handayani and Haribowo. 2008. Askep pada Klien dengan Gangguan Sistem Hematologi. Jakarta: Salemba Medika.

Hoffbrand et al. 2005. Hematologi. Jakarta: Buku Kedokteran EGG.

http://id.wikipedia.org/wiki/Leukemia, Accessed on October 23, 20011.

http://www.infopenyakit.com/2008/01/penyakit-leukemia-kanker-darah.html, Accessed on October 23, 20011.

http://www.cancerhelps.com/pengobatan-kanker-darah.htm, Accessed on October 23, 20011.