I.

INTRODUCTION
Acute Leukemia is a case that is quite common nowadays, however, I have noticed
that this case is also one of the Diseases that is oftentimes ignored or underestimated by
most Filipinos and not really being taken seriously which of course, as a result of
neglection, oftentimes leads to fatal consequences. As a nursing student, I have
personally chosen this case in order to improve and widen my knowledge and
understanding concerning Acute Leukemia, its clinical manifestations, possible causes,
cure and prevention, among others. Having to gain knowledge and light to this case, it
would give such advantage not just for a student nurse but also, it will serve as powerful
tool for other people who wants to have better understanding what is acute myeloid
leukemia really is about and why do we have to take this as serious as the other diseases.
Leukemia has always been called or known as a “Cancer of the Blood”, in that case, it is
proper to start learning what is cancer and its difference from the acute leukemia.

What is cancer? What is Leukemia? Cancer is when cells in the body change and
grow out of control. Your body is made up of tiny building blocks called cells. Normal cells
grow when your body needs them, and die when your body does not need them any
longer. Cancer is made up of abnormal cells that grow even though your body doesn’t
need them. In most types of cancers, the abnormal cells grow to form a lump or mass
called a tumor.

Leukemia, on the other hand is different from most other cancers. Leukemia is
cancer that starts in the bone marrow. The bone marrow is where new blood cells are
made. It's a thick, spongy liquid inside your bones. Leukemia starts in early forms of blood
cells, usually white blood cells, which help fight infections. When you have leukemia, your
body makes too many blood cells, and they aren’t normal. Leukemia cells do not usually
form tumors. But they can travel in the blood and go all over the body. That means they
can reach almost any organ. So, leukemia can cause problems and be found in many
different ways, depending on which organs are involved. There many different types of
leukemia but the four most important forms are derived from only two types of cells,
lymphocytes and myelocytes. Acute myeloid Leukemia is one of the types of leukemia
however AML affects myeloid cells and grows quickly. AML accounts for more than
13,000 new cases of leukemia each year. It occurs in both adults and children. The term
“acute” means that the leukemia can progress quickly, and if not treated, would probably
be fatal within a few months.

1
III. PATIENT PROFILE
Name: Mr. A+
Age: 77 years old
Sex: Male
Civil Status: Married
Religion: Roman Catholic
Date of Admission: July 18, 2018 5:15 PM
Room No.: 326
Complaints: Generalized body weakness & chest Pain
Diagnosis: Acute myeloid Leukemia
Physician: Dr. L

IV. INITIAL DATA BASE

Family Structure, Characteristics and Dynamic or Relational Patterns
Mr.A, 77 yrs. Old, male, Filipino Roman Catholic is a married man and has seven
children, all of which are all college graduates and are already professionals. The
patient used to work as a public school teacher in aborlan, Palawan as well as in
quezon,Palawan and is currently a retired teacher for about 5 years now.
The Family A is a Nuclear type of Family. Mr. A was a former public-school teacher
in Aborlan and in Quezon, Palawan. He retired from his teaching profession 5 years ago
and is currently working on his coconut farm called as “koprasan”, however this job
according to him is not really a heavy one since he has hired some people to help him
tend the farm and according to Mr. A it is only a past time which he happens to really
enjoy doing. Their farmland is actually a little farther from the town proper that is why he
and his wife doesn’t see or live in the same house most of the time because his wife,
Mrs.A,a housekeeper, looks out for their house and a small business in the town proper.
the children of mr and mrs A are all graduates in college and is currently living separately.
Mr.A eldest is a female and is presently assigned as a public teacher in Puerto princesa
city. The second child, also a female, is a business administrator in Iloilo city. The third
child, female, is also a public teacher in aborlan, Palawan. The fourth child is a male who
is an agriculture engineer and pursued his dream of working on his own farm in aborlan
and in Puerto princesa city. The fifth child of mr. And mrs. A is a female, also a public
teacher. The sixth is a male, and is a civil engineer who is assigned to several places in
Palawan may it be south or north. Last but not the least is the youngest child, a female
and is a human resource and currently living and working in Manila, Philippines. The
family A may be living and working in different places however according to the patient
and from observation, the distance between them doesn’t really affects how close
together they are to each other. The children having their own family helps their parents
with their finances however according to mr.A+, he doesn’t obliged their children to do it
since his and his wife financial status is enough already to give them a comfortable life
especially with his monthly pension from the government and the earnings they gain from
their small business in town and from their coconut farm. Still, the children who obviously
looked up to their parents and loves them dearly really make sure that each of them gives
support to their parents may it be financial or emotional since teamwork is a vital thing for
the family A+.

2
 Socio-economic and Cultural Characteristics
As a retired teacher who owns a small business and a coconut farm plus a
monthly pension, Mr and Mrs. A has income of around P40,000.00 to P70,000.00 and
some additional when their children gives them financial supports as well. This amount
of money they receive each month is already more than enough for Mr. And Mrs A and
according to Mr. Their way of living is not as extravagant as others. According to Mr. A,
he and his wife is living a simple life. Mr. A is a Palaweno by blood and was born and
grew up in Quezon, Palawan and only started living in Aborlan when he was assigned
there as a public teacher and met his Ilongga wife, Mrs. A . Mr. And Mrs. A are both
Roman Catholics and is religiously inclined.
Home and Environment
Mr. And Mrs. A lives separately from each other most of the time. Mrs. A is living
in their family’s house in the town proper while she attends to their small business while
Mr.A+ lives in the coconut farm a little farther from the town proper. Mrs. Visits her
husband as much as she can and brings or cooks him his favourite viands. The farmland
which mr.A+ spends most of his time and currently living in is about 5 kilometres away
from the town proper. he lives in a semi concrete nipa hut which is surrounded by coconut
trees, some mango trees and other vegetables. The neighbours are quiet far from his
house however there is one smaller hut near his place where his main farm caretakers
lives. The house has water faucet system that is coming from a deep well inside their
farm. Some carabao muddy puddles can also be seen around 20 meters away from his
nipa hut. The area is well ventilated with fresh air blowing. The area is quiet and very
peaceful with only the sound of crickets or cicadas can be heard during the quiet nights
as well as the croaking frogs. Of course, mosquitoes are everywhere especially in farms
so mr. A+ burns some coconut husks each sunset to scare off mosquitoes around the
area of his house.
Health History of Each Family Members
Mrs. and Mr. A+ were both living healthy before until Mr. A+ feel weak and has
chest pain. Thy couple has no history of major illness except from having simple colds
and cough from time to time. Mr. A+ reported no history of hyper or hypertension before.
Their children of Mr. And Mrs A+ also have no history of any hospitalizations or major
illnesses.
Values, Habits, Practices on Health Promotion, Maintenance and Disease
Prevention
Washing the raw foods thoroughly before cooking it is very essential according for
Mr.A+ to avoid contamination. Washing his hands before eating and bathing every
morning and evening is also his way of staying clean. He also loves to stay active and get
the exercise he needs, to keep herself fit and healthy by working on his farmland. he also
goes to clinics to have his blood pressure checked and visits the doctor each month or
two just to check how is his health.Whenever he feels ill or any member of his family, he
would go to the doctor immediately and dont self-medicate however the family especially
Mr.A+ also believes in traditional healings like herbal medicines or “hilot” and admitted of
having to go to the “albularyos” or “quack doctors” at times.

V. PATIENT'S HISTORY
Present Illness
July 18,2018 5:15 PM, Mr.A+ is admitted to the Adventist Hospital Palawan due to the
complain of chest pain and generalized body weakness. He reported having chest pain,
weakness, easily fatigability as well as difficulty of breathing for about 5 days ago. Before
coming to Adventists Hospital, he was first admitted in Aborlan Medical Center for 2 days
and later on advised by his doctor to transfer to Adventist Hospital in Puerto princesa to
seek for a better treatment and gain more accurate diagnosis. Mr.A’s family worries that
the head of the family would be more stressed when he heards the truth that why his

3
family decided not to tell him what is the real cause of his illness. Mr A thought his illness
is just lack of nutrition because. He is receiving blood transfusions of packed red blood
cell and other interventions as doctors order.
Past Health History
Mr. A reported that he once had a malaria before but that was when he was still a
child about 13 years old or so. He never had measles or any other childhood illness
common during his childhood times but remembers that he got some usual colds and
coughs during rainy seasons. He got hospitalized before when he is still young but
couldn’t remember what is the cause. He once was an occasional drinker but already
stopped ten years ago. He is an active person during his teenage and young adulthood
years. He is a basketball player in their school both when he was still a student and also
a young teacher. He was also a good carpenter before works hard aside from being a
public teacher. According to Mr.A he is very active and strong during his younger years.
Family Health History
Mr.A ‘s father died from an accident at the age of 60 while Mr.A’s mother diead at the
age of 70 with having Alzheimer’s . according to Mr. A he have no memeories of his
parents getting really sick or ever confined to any hospitals before. According to Mr. A
his parents were as strong as a caracbao when he was young and couldn’t recall seeing
them sick. Mr. A 7 more siblings. The eldest is a male,MR.1 died of old age, the second
is a female,MRS.2,who died after losing consciousness in one regular day, the third one
is also a female Mrs.3, died of old age,the fourth one,MRS.4, is female and is still alive,
the fifth one, MR.5, died from Severe Abdominal Pain which the family thinks is a sever
ulcer, the sisxth is Mr.A, then the seventh sibling,MRS.7, is a female who is still alive
while the youngest brother,MR.8, died due to a bone cancer as MR. A’s children heard
from their relatives.
GENOGRAM

LEGEND:
Dad A+ Lost Consciousness Bone Marrow
and Died Cancer

Mom A+ Ulcer Unknown death

MR.1 MRS.7 Healthy

MRS.2 MR.8 Accident

MRS.3 MALE ALZHEIMER’S

4
 MRS.5 FEMALE ALIVE
MR.6 DECEASED MR.A+

VI. GROWTH AND DEVELOPMENT THEORY

The patient belongs to the Late adulthood (old age) which is generally considered to
begin at about age 65. Erik Erikson suggests that at this time it is important to find
meaning and satisfaction in life rather than to become bitter and disillusioned, that is, to
resolve the conflict of integrity vs. despair. Many older people are happy and engaged in
a variety of activities.
Theories of successful aging. Theories of successful aging include the following:
The disengagement theory states that as people age, their withdrawal from society is
normal and desirable as it relieves them of responsibilities and roles that have become
difficult. This process also opens up opportunities for younger people; society benefits
as more‐energetic young people fill the vacated positions.
The activity theory contends that activity is necessary to maintain a “life of quality,”
that is, that one must “use it or lose it” no matter what one's age and that people who
remain active in all respects—physically, mentally, and socially—adjust better to the
aging process. Proponents of this theory believe that activities of earlier years should be
maintained as long as possible.
Ageism. Ageism may be defined as the prejudice or discrimination that occurs on the
basis of age. Although it can be used against people of all ages, older people are most
frequently its target and it may often result in forced retirement. Stereotyping of the
elderly is also an aspect of ageism, as seen in such a statement as “He drives like a
little old lady.”
Physical changes. People typically reach the peak of their physical strength and
endurance during their twenties and then gradually decline. In later adulthood, a variety
of physiological changes may occur, including some degree of atrophy of the brain and
a decrease in the rate of neural processes. The respiratory and circulatory systems are
less efficient, and changes in the gastrointestinal tract may lead to increased
constipation. Bone mass diminishes, especially among women, leading to bone density
disorders such as osteoporosis. Muscles become weaker unless exercise programs are
followed. The skin dries and becomes less flexible. Hair loss occurs in both sexes.
There is also decreased sensitivity in all of the sensory modalities, including olfaction,
taste, touch, hearing, and vision.
Cognitive changes. The study of cognitive changes in the older population is complex.
Response speeds (neural and motor) have been reported to decline; some researchers
believe that age‐related decrease in working memory is the crucial factor underlying
poorer performance by the elderly on cognitive tasks.
Intellectual changes in late adulthood do not always result in reduction of ability.
While fluid intelligence (the ability to see and to use patterns and relationships to solve
problems) does decline in later years, crystallized intelligence (the ability to use
accumulated information to solve problems and make decisions) has been shown to
rise slightly over the entire life span. K. Warner Schaie and Sherry Willis reported that a
decline in cognitive performance could be reversed in 40% to 60% of elderly people
who were given remedial training.

5
Dementias are usually responsible for cognitive defects seen in older people. These
disorders, however, occur only in about 15% of people over 65. The leading cause of
dementia in the United States is Alzheimer's disease, a progressive, eventually fatal
disease that begins with confusion and memory lapses and ends with the loss of ability
to care for oneself.

Retirement. Retirement at age 65 is the conventional choice for many people, although
some work until much later. People have been found to be happier in retirement if they
are not forced to retire before they are ready and if they have enough income to
maintain an adequate living standard. Chronic health problems such as arthritis,
rheumatism, and hypertension increasingly interfere with the quality of life of most
individuals as they age.

Widowhood. Women tend to marry men older than they are and, on average, live 5 to
7 years longer than men. One study found ten times as many widows as widowers.
Widowhood is particularly stressful if the death of the spouse occurs early in life; close
support of friends, particularly other widows, can be very helpful.

Death and dying. Death and dying has been studied extensively by Elisabeth Kübler‐
Ross, who suggested that terminally ill patients display the following five basic reactions

Denial, an attempt to deny the reality and to isolate oneself from the event, is frequently
the first reaction.

Anger frequently follows, as the person envies the living and asks, “Why should I be the
one to die?”

Bargaining may occur; the person pleads to God or others for more time.

As the end nears, recognition that death is inevitable and that separation from family will
occur leads to feelings of exhaustion, futility, and deep depression.

Acceptance often follows if death is not sudden, and the person finds peace with the
inevitable.
People who are dying are sometimes placed in a hospice, a hospital for the terminally ill
that attempts to maintain a good quality of life for the patient and the family during the
final days. In a predictable pattern after a loved one's death, initial shock is followed by
grief, followed by apathy and depression, which may continue for weeks. Support
groups and counseling can help in successfully working through this process.

VII. PATTERNS OF FUNCTIONING

Health perception-health management patterns
The family/patient also understand that certain habits must be lessen and
eliminated by quitting her smoking habit and excessive intake of caffeine.

6
 The family knows that going to doctor is still best rather than doing self-
medications.
The family also understand the risk of not checking blood pressure regularly.
Nutritional or metabolic pattern
The family understand the importance of eating only healthy foods by means of
avoiding fatty foods,eating vegetables ,fruits and fish only and also exercising.
The patient avoids drinking alcohol as it only gives you bad health effects than
good.
Elimination Pattern
The patient urinates about 500ml every 8 hours
The patient regularly eliminates every morning daily.
The patient reported problem or pain with elimination after one week of being
confined to Adventist hospital
Activity- Exercise Pattern
The patient makes sure he get enough exercise he uses his farm works as a
form of exercise and by pastoring his pets carabaos.
The patient on the also uses walking as his means of exercise, he would walk
around the farm ,he understands that heavy exercise is not going to be good for his
blood pressure especially at his age.
Sleep-rest Pattern
The patients gets 8-9 hours of sleep.
Before the patient was confined to the hospital for acute leukemia, The patient
usually sleeps before 8 oclock and wakes up at 5 am to prepare for work and sleeps
during "siesta"or afternoon time.
During patient confinement,he remains on bed and sleeps most of the time and
wakes up only to feed and when the nurses gaves him medications or he wants to talk
or eat.
Cognitive-Perceptual Pattern
The patient has no problems identifying names and faces of her significant others
and relatives.
The patient is still oriented to time, place and date.
The patient has no sensory defect but is noted to have general body weakness
and dizziness.
Sexual Reproductive
The late adulthood age and his illness has made the patient sexually inactive.
Stress coping Pattern
The love and support of the family and relatives is what’s keeping him positive
and happy in spite of the stress that his disease is causing him and his family. The
assurance and encouragement keep the patient and family united and positive.
Self-perception /Self-concept
Despite having the illness patient remains positive and joyful as well as
cooperative.
However the patient has no idea about the real score of his illness and his family
is aware of the consequences of not taking the surgery method that the doctor had
advised to them and seemed to have fully accepted it and leaving it to faith of God.
7
 Roles and relationship
the Family is open to each other and is unitedly working for their future. They
help each other and support each one. Mr.A’s children is truly supportive and loves and
cares for him sincerely however the thought of scaring of hurting their father, MR. A by
telling him his real heath status is so painful for them that they choose not to tell him the
truth.
Values/Belief Pattern
The family has always been Catholic and that they are the type of family who are
religiously worshipping the God every Sunday and by that they leave MR. A’s condition
to the faith of God.

VIII. PHYSICAL ASSESSMENT

PATTERNS OF CLINICAL OTHER SOURCES

FUNCTIONING EXAMINATION
A. RESPIRATORY Inspection: Results of chest X-ray
Has history of cough presence of slight Results of sputum
(productive) productive cough examination
And History and present illness Medications being taken
of Pneumonia in both lungs Color: yellowish
no nasal discharges with
nasal oxygen.

.None smoker Respiratory rate & Results of chest X-ray

No Hx of surgery related to rhythm & pattern
lung RR: _19___cpm Results of sputum
problem examination
with hx in difficulty of breathing normal/breath effortless
during sleep and awake time Medications being taken
normal breath
sound/clear

CIRCULATORY BP: 110/50mmHg ECG results

History of : dizziness,chest PR:69bpm Blood chemistry
pains Normal HR Hematology
location: chest area regular rhythm Medications taken
rating scale 1-10: __7__ irregular
not radiating Normal pulse
Duration: ___2-3_mins. weak/small pulses
associated symptoms: presence of swelling at
nausea the extremities
relief measures specifically both feet and
done:_drinking water and legs
medications_ Positive minimal
Causes of attacks: varicosities of
_____Sudden_______ extremeties
discolored parts:
edema and Swelling where:pallor
experienced in peripherals cold extremities
associated with what edema : where:both feet
generalized body weakness anf lower legs, non-
and pallor pitting

easy fatigability,
8
 palpitations
tightness of chest
Capillary refill: more than
2 secs.
Color of nail beds:
pale
Color of mucus
membrane: _____pale
pale nail bed

FOOD AND FLUID INTAKE General state of health, Diet prescribed, fluids
The patient usual foods are prescribed, oral,
body builds nutritional
parenteral,
fruits, rice with Vegetables as a
state.
viand. Most of the fruits and Results of GI tract x-
Height: 5.2ft. Weight:
rays, liver function tests,
vegetables he eats are
_55_kgs. Nutritional blood sugar level
produced and harvested from
status of :
their own farmland and in some
Skin:poor skin turgor.
occasion he would buy
Severely
fish.however he doesn’t like
dehydrated with
eating pork meat or other kinds
positive scaling off of
of meat . MR.A+ eats his meal
old skins.
3 times a day his breakfast is
evenly distributed fine
usually done at 7:30 am, lunch
hair
at 12pm and dinner at 6:30pm
or 7 pm
Dry skin
No known Food allergies
color of skin:
Patient loves eating vegetables
dark skin
and local fruits, he sometimes
Texture: rough/thick
eat fish but dislikes pork and
Temp. & moisture of skin:
other meat since its not good
Cold and dry
for the health as he said. He
Scalp/hair:
drinks 8 or more glasses of
gray hair
water everyday depending on
negative dandruff
how much hot he feels or how
Brittle hair
thirsty he gets.
scaly dry
he used to take alcohol of all
Hydration of mucus
kinds but only occasionally.
membranes: dry
MR.A+ stopped drinking
Mouth:
alcohol 10 years ago to live a
negative dentures
better lifestyle for his old age.
dental carries on both
upper and lower molars
and upper front teeth
Dry lips

9
ELIMINATION
How many times does patient
void/day?(specify): ___once a
day_______
Usual time: morning
Char. Of stool: soft
Color: brownish
Char. Of stool: soft
Color: brownish
Urinary frequency :
Amount: (specify): ____1050 ml
per day_
Urine color:
straw to amber
REGULATORY MECHANISMS
Positive history and reoccurring
Fever associated with blood
transfusion and pneumonia in
both lungs. Relief measures of
Tepid Sponge Bath and
administering antifever meds.
HYGIENE
How often does patient take a
bath? Once a day
Time? around 9am to 10 am
Patient uses any shampoo
available. he Brush teeth his
teeth 3 times day after every
meal. He changes clothes
everyday. Patient has reported
no Allergies to soap, shampoo.
MR. A+ beliefs/practices related
to personal hygiene is avoiding
bathing during night time.
ACTIVITY & EXERCISE
Usual exercise at home:
________ frequency & time
done:_________
Joint stiffness experienced.
Hx. Of gout arthritis,
Paralysis: _________
since when: _______
Prosthetic/devises
Aids to mobility: _________
Results of UGI series,
barium enema, etc.
Stool exam result.
Urinalysis result.
Kidney function tests
Temp.: __37.4__°C Results of blood
(Axilla) examination indicative
Skin: dry and pale of infection process.
perspiration noted Medications taken.
General appearance,
neat, Toiletries use.
HEAD: hair distribution Brand of soap,
and texture. toothbrush/toothpaste,
Scalp- negative Shampoo use.
secretions, Lesion
Dandruff, pediculosis
Skull: even contour and
ssize
Nails- long nails
Mouth- no Unpleasant
odor of patient noted
Physical bearing, stature, X-RAY results for
gait, posture, movement, fractures, dislocations.
extent of range of joint Lab results which would
motion? Limitations of signify musculo-skeletal
movements? Fractures? abnormalities.
Joint stiffness
Contracture deformities?
Dislocation? Muscle
pain? Cramps?
Amputated parts? Use of
crutches, cane, or other
walking aids.
Neck: symmetry of
musculature, abnormal
masses, swelling,
10
 enlargement of thyroid
glands, presence of
lymph nodes, vein
prominence, scars,
moles stiffness of neck?

. REST AND SLEEP Looks tired and sleepy Rest prescription of

No. hours usually slept: ___8 or physician
more hours for 24hrs___
Time of arising and retiring: Possible cause:
_5:00 am___
__medications and vital
Daytime naps signs taking_______
How long:___30 mins to 1
Actual no. of hours slept:
hour___
Favorite sleeping position; __10-12 hrs per 24
side-lying
hours____
No. of pillows used: __1__pcs.
use Mosquito net Interrupted sleep
Bedtime rituals
Describe: __pray before
sleeping_________

COMMUNICATION AND EYE: even distribution of Results of sight and

SPECIAL SENSES lashes, Whitish to hearing tests.
Right handed Yellowish Color of sclera,
Use of eye glasses dryness or lacrimation.
For how long the patient is
wearing these?__around 17
years _____
Visual and auditory
disturbances:
yes

Speech disturbances:
no
Dialect or language
spoken:_Cuyunin,Bisaya,
Tagalog,Palawan,_English__

COGNITION & PERCEPTION Oriented: yes Results of neurological

(sensory) exams. Or tests
person time place.
HX of convulsions
no Level of consciousness
Hx of loss of consciousness: no
alert
Hx of epilepsy: no
Suffering from seizures
Medications taken : no
while in your care? no
Response to stimuli:
Tactile yes
Verbal yes
Coherence of
expression:yes

11
 RELIGIOUS LIFE Religious medals worn: Advices from religious
Religious affiliation ministers
none
Roman Catholic
Need for religious
counselor: none
Ability to meet own
spiritual needs:none

IX. ANATOMY AND PHYSIOLOGY

The immune system defends the body from invading organisms that may cause disease.
One part of the immune system uses barriers to protect the body from foreign substances.
These barriers include the skin and the mucous membranes, which line all body cavities;
and protective chemicals, such as enzymes in saliva and tears that destroy bacteria.
Another part of the immune system uses lymphocytes, specialized white blood cells
that respond to specific types of foreign invaders. B lymphocytes produce proteins called
antibodies, which circulate in the blood and attack specific disease-causing organisms. T
lymphocytes attack invading organisms directly

COMPONENTS OF THE IMMUNE SYSTEM

MACROPHAGE
A macrophage, in yellow, engulfs and consumes a bacterium. Macrophages
are large phagocytes, cells that wander through the body consuming foreignparticles
such as dust, asbestos particles, and bacteria. They help protect the body against
infection. White blood cells are the mainstay of the immune system. Some white blood
cells, known as macrophages, play a function in innate immunity surrounding,
ingesting, and destroying invading bacteria and other foreign organisms in a
process called phagocytosis (literally, “cell eating”), which is part of the
inflammatory reaction. Macrophages also play an important role in adaptiveimmunity in
that they attach to invading antigens and deliver them to be destroyed by other
components of the adaptive immune system.

LYMPHOCYTES
Lymphocytes are specialized white blood cells whose function is to identify and destroy
invading antigens. All lymphocytes begin as “stem cells” in the bone marrow,
the soft tissue that fills most bone cavities, but they mature in
two differentplaces. Some lymphocytes mature in the bone marrow and are called Lymp
hocytes. B lymphocytes, or B cells, make antibodies, which circulate through the blood
and other body fluids, binding to antigens and helping to destroy them in humoral
immune responses. Other lymphocytes, called T lymphocytes, or T cells,
mature in the thymus, a small glandular organ located behind the breastbone. Some
T lymphocytes, called cytotoxic (cell-poisoning) or killer T lymphocytes,
Generatecellmediated immune responses, directly destroying cells that have specificant
igens on their surface that are recognized by the killer T cells.Helper T lymphocytes,
a second kind of T lymphocyte, regulate the immune system by
controlling the strength and quality of all immune responses. Most contact between
antigens and lymphocytes occurs in the lymphoid organs

12
—the lymph nodes, spleen, and tonsils, as well as specialized areas of the intestine and
lungs Mature lymphocytes constantly travel
throughthe blood to the lymphoid organs and then back to the blood again. This
recirculation ensures that the body is continuously monitored for invadingsubstances.

BONE MARROW

Bone Marrow, soft, pulpy tissue that fills the cavities of bones, occurring in two forms,
red and yellow. One of the largest tissues in the body, bone marrow accounts for 2 to 5
percent of an adult’s weight. Red marrow, present in all bones at birth, serves as the
blood manufacturing center. As an infant matures, most of the red marrow in the shaft
of long bones, such as the armand leg bones, is gradually replaced by yellow marrow.
Yellow marrow is composed primarily of specialized fat cells.

STRUCTURE
Red marrow consists primarily of a loose, soft network of blood vessels and protein
fibers interspersed with developing blood cells. The blood vessels are termed the
vascular component, and the protein fibers and developing blood cells collectively are
referred to as the stroma, or the extravascular component. The protein fibers crisscross
the marrow, forming a meshwork that supports the developing blood cells clustered in
the spaces between the fibers. Red marrow contains a rich blood supply.
Arteries transport blood containing oxygen anand nutrientsnto the marrow, and veins
remove blood containing carbon dioxide and other wastes. The arteries and veins are
connected by capillaries, blood vessels that branch throughout the
marrow. In various places, the capillaries balloon out, forming numerous thin, blood-
filled cavities. These cavities are called sinusoids, and they assist in blood-cell
production. Yellow marrow is so named because it is composed of yellow fat cells
interspersed in a rich mesh of connective tissue that also supports many blood vessels.
While not usually actively involved in blood formation, in an emergency yellow marrow is
replaced by blood-forming red marrow when the body needs more blood

MARROW FUNCTION
Red marrow produces all of the body’s blood cells—red blood cells, white blood cells,
and platelets. Red blood cells in the circulatory system transport oxygen to body tissues
and carbon dioxide away from tissues. White blood cells are critical for fighting
bacteria and other foreign invaders of the body. Platelets are essential for the formation
of blood clots to heal wounds. Within red bone marrow, all blood cells originate from a
13
single type of cell, called ahematopoietic stem cell. Stimulated by hormones and growth
factors, these stem cells divide to produce immature, or progenitor blood cells. Most of
these progenitor cells remain in the stromaand rapidly undergo a series of cell divisions,
producing either red blood cells or white bloodcells. At any one time, the stroma
consists largely of progenitor cells in various stages of development. At the appropriate
developmental stage, the fresh, new cells squeeze through thewalls of the capillaries.
From there, the cells leave the bone and enter the body’s circulatorysystem. Some
progenitor cells migrate to the sinusoids, where they produce platelets, which alsotravel
to the circulatory system via the capillaries. Although stem cells are relatively rare—
about1 in every 10,000 marrow cells is a stem cell—they typically produce the
forerunners of anestimated 2 million red cells per second and 2 billion platelets per day.
However, if significantamounts of blood are lost or other conditions reduce the supply of
oxygen to tissues, the kidneyssecrete the hormone erythropoietin. This hormone
stimulates stem cells to produce more red blood cells. To fight off infection, hormones
collectively termed
colony stimulating growth factors
are released by the immune system. These hormones stimulate the stem cells to
producemore infection-fighting white blood cells. And in severe cases, the body
converts yellow marrowinto red marrow to help produce needed blood cells.

Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow— the
spongy tissue inside bones where blood cells are made.
It's called acute leukemia because it progresses rapidly and affects immature blood
cells, rather than mature ones. It's called myelogenous (MI-uh-loj-uh-nus) leukemia
because it affects a group of white blood cells called the myeloid cells, which normally
develop into the various types of mature blood cells, such as red blood cells, white
blood cells and platelets. This type
of leukemia is also known as acute myeloid leukemia, acute myeloblastic leukemia, acut
egranulocytic leukemia and acute nonlymphocytic leukemia. Normally, your bone
marrow produces immature cells (stem cells) in a controlled way, and they mature and
specialize into the various types of blood cells as needed. In people with acute
myelogenous leukemia, the bone marrow produces immature cells that usually develop
into a type of abnormal white blood cell. These abnormal cells aren't able to mature and
perform their usual functions. Even worse, they multiply rapidly and can crowd out
healthy cells, leaving a person with acute myelogenous leukemia vulnerable to infection,
anemia or easy bleeding.Leukemia cells can also spread outside the blood to other
parts of your body.Acute myelogenousleukemia is the most common form of leukemia.
It worsens quickly if not treated, but it
initiallyresponds well to treatment. Unfortunately, many people with acute myelogenous
leukemiaexperience a relapse. Much research is focused on decreasing the risk
of relapse and improvingthe long-term outcomes for people with acute myelogenous
leukemia

CAUSES

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The cause of acute myelogenous leukemia is damage to the DNA of developing cells in
your bone marrow. Under normal circumstances, your DNA is like a set of instructions for
your cells, telling them how and when to grow and divide. Certain genes on your DNA
called oncogenes promote cell division. Other genes, called tumor suppressor genes,
slow down celldivision and cause cells to die at the appropriate times.Acute myelogenous
leukemia can occur when damage to DNA turns on oncogenes or turns off tumor
suppressor genes. When this happens, blood cell production goes awry. The bone
marrow produces immature cells that develop into leukemic white blood cells called
myeloblasts. Theseabnormal cells are unable to function properly, and they can build up
and crowd out healthycells.The DNA mutations that cause leukemia are usually acquired
— rather than inherited — but researchers and doctors don't always understand exactly
how. In some cases, damage to DNAis the result of exposure to cancer-causing
chemicals, including previous chemotherapy for other cancers. There's also a chance of
AML progressing from other blood diseases and chronicleukemias,
such as chronic myelogenous leukemia, myelodysplasia or other
disorders in whichthe bone marrow produces too much of certain types of blood cells (m
yeloproliferativedisorders).

RISK FACTORS
The risk of acute myelogenous leukemia increases with age. It's most prevalent in people
in their 60s and older. The disorder is also more common in males than in females. Other
possible risk factors include:

 Cancer therapy.
People who've had certain types of chemotherapy andradiation therapy or treatm
ent for childhood acute lymphocytic leukemia (ALL) may have a greater risk of
developing AML.

 Exposure to radiation and certain chemicals.

People exposed to very high levels of radiation, such as survivors of an atomic
bomb blast or a nuclear reactor accident, have an increased risk of developing
AML.
 Exposure to certain chemicals, such as benzene — which is found in unleaded
gasoline and used by the chemical industry — also is linked to greater risk of AML.
 Smoking.
AML is linked to cigarette smoke, which contains benzene and other known
cancer-causing chemicals. Smokers older than 60 face twice the risk of AML that
nonsmokers do.

 Other blood disorders.

People who've had another blood disorder, such as myelodysplasia, polycythemia
vera or thrombocythemia, are at greater risk of developing AML.

 Genetic disorders.
Certain genetic disorders, such as Down syndrome, are associated with an
increased risk of AML.

15
X. PATHOPHYSIOLOGY
When a large number of blasts (leukemic cells) appear in the bone marrow, several things
happen. As the leukemic blast cells accumulate in the bone marrow, they begin to crowd
out the normal blood cells that develop there. Eventually, they take up so much room that
red blood cells, platelets, and normal white blood cells cannot be produced. When that
happens, the young person develops symptoms indicating that normal blood cells are not
being manufactured in adequate numbers: If blood platelets are crowded out in the bone
marrow, the young person may have bleeding problems and unusual bruising. If the
normal, mature kind of white cells known as neutrophils are crowded out by the blasts,
there will be no cells to combat bacteria, and infections may occur. In some cases,
leukemic blasts may spill over from the bone marrow into the blood, where they can
be seen by microscopic examination. This may cause arise in the number of white cells
in the blood (the white blood cell count). In other cases, only a few blasts appear in the
blood, and the white cell count does not change much. When leukemic blasts are present
in the blood, they may be carried to other places in the body and enter various body
organs. Sometimes they grow in these organs as well as in the bone marrow.
If red blood cells are crowded out by leukemic cells, the blood will look thin, which makes
the patient look pale. The person also may be tired, because the thin blood cannot carry
enough oxygen to the heart, lungs, and muscles.

CANCER CELLS NORMAL CELLS

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XI. LABORATORY STUDY

DATE LABORATORY RESULT NORMAL INTERPRETATION SIGNIFICANCE

EXAMS VALUES

HEMATOLOGY

JULY 85g/L M= 135- - Hemoglobin is Hemoglobin is a

24, HEMOGLOBIN 180g/L below normal protein in your red
2018 (Hgb) values blood cells that
-decrease carries oxygen to
hemoglobin is a your body's organs
possible sign of and tissues and
anemia transports carbon
-while increase can dioxide from your
occur due to: organs and tissues
Haemochromatosis back to your lungs.
, emphysema,
polycythemia

-Hematocrit is The hematocrit is

HEMATOCRI 0.26vol% M= 0.41- below normal the proportion, by
T 0.50 vol% values volume, of the
(HCT) -low values may blood that consists
indicate: anemia, of red blood cells
leukemia, bone
marrow failure

-RBC is below RBC’s primary

RED BLOOD 2.6 x M= 4.5- normal values function of red
CELL 12 12 -Abnormal RBC blood cells is to
10 /L 5.9x10 /
(RBC) values may transport oxygen
L indicate: iron to body cells and
deficiency, deliver carbon
thalassemia, liver dioxide to the
disease, renal lungs.
disease, sickle cell
anemia

-WBC is above WBCs, also called

WHITE 51.7 4.4- normal values leukocytes or
BLOOD 9 9 -elevated values leucocytes, are
x10 /L 11.0x10 /
CELL may indicate
L

17
 (WBC) (leukocytosis): the cells of the
infection, common immune system
cold, tuberculosis, that are involved in
allergy, and protecting the
glandular fever body against both
disease and foreign
invaders.

-Platelet is lower Also known as

PLATELE 34x10ˆ9/L 150-450 normal values thrombocytes, are
T x10ˆ9/L -A low platelet small elements
count known as formed in the red
thrombocytopenia bone marrow.
. It can also They are actually
indicate other fragments of
types of disease megakaryocyte
such as cytoplasm
Leukemia, Some (precursor cell to
types of anemia, the platelet.)
Viral infections, Platelets help to
such as hepatitis control bleeding.
C or HIV, There are two
Chemotherapy means by which
drugs and platelets are able to
Heavy alcohol do this: one is by
consumption forming an
occlusion at small
injurious openings
in blood vessels;
and the second by
a thromboplastic
function which
stimulates the
coagulation
cascade.

-MCV is above The average

Mean 97.7 80-96fl normal values. volume or size of a
Corpuscula results show that red blood cell
r Volume the red blood cells
(MCV) are larger than
normal and it may
indicate:A vitamin
B12 deficiency, A
deficiency in folic
acid, another type
of B vitamin, Liver

18
 disease and
Hypothyroidism

-MCH is within Mean Corpuscular

Mean 32.6 27.5 – 33.2 normal values Hemoglobin
Corpuscula (MCH) gives the
r average weight of

Hemoglobi hemoglobin in the

n red blood cell
(MCH)

-MCHC is below The average

Mean 33.3 g/dL 33.4- normal values concentration of
Corpuscula 35.5g/dL -Low MCHC hemoglobin in red
r means that a unit blood cells.
Hemoglobi of packed R.B.C.’s
n contain less
Concentrat hemoglobin than
ion normal, decreased
(MCHC) levels may indicate
iron deficiency,
blood loss, B6
deficiency of
thalassemia.

-RDW-CV is
Red Cell 23.2 11.6- above normal
Distributio 14.6% values
n Width- - Elevated levels
Coefficient may indicate iron
of deficiency or other
Variation conditions with a
(RDW-CV) wide distribution
of various cell
sizes

Differential count:
Granulocytes

19
 -Neutrophils is Neutrophils are a
Segmenters 50 50-70% within normal type of white
(Neutrophil values blood cell. In fact,
s) most of the WBC
that lead the
immune system’s
response are
neutrophils.

-Basophil is above Responsible for

Basophils 3 0-1% normal values inflammatory
-Increase may reactions during
indicate: blood immune response,
cancers (in rare as well as in the
cases) formation of acute
and chronic
allergic diseases,
including
anaphylaxis,
asthma atopic
dermatitis and hay
fever. They can
perform
phagocytosis (cell
eating), produce
histamine and
serotonin that
induce
inflammation, and
heparin that
prevents blood
clotting.

-Eosinophils is Eosinophils are a

Eosinophils 0 0-4% within normal type WBC that
values play an important
role in the body's
response to allergic
reactions, asthma,
and infection with
parasites.

AGRANULOCYTES

20
 -Lymphocytes is Lymphocytes are
LYMPHO 4 20-40% below normal an important part
CYTES values of the immune
decrease: not system. They help
usually clinically fight off diseases,
significant so it's normal to
see a temporary
rise in the number
of lymphocytes
after an infection.

-Monocytes is Monocytes are the

MONOCY 43 0-7% above normal biggest of all white
TES values blood cells that
-Increase may play an important
indicate: usually role in the defense
not significant, against germs and
infection, in inflammation.
granulomatous
disease (sarcoid),
collagen vascular
disease

CLINICAL CHEMISTRY I

DATE TEST RESULT REFERENCE INTERPRETATION SIGNIFICANCE

VALUES
-Creatinine is above -Creatinine is a
normal values waste product from
CREATININE 1.34 0.7-
the normal
1.20mg/dL -Elevated creatinine
July breakdown of
level signifies
18,2018 muscle tissue. As
impaired kidney
creatinine is
function or kidney
produced, it's
disease. Abnormally
filtered through the
high levels of
kidneys and
creatinine thus warn
excreted in urine.
of possible
Doctors measure
malfunction or
the blood creatinine
failure of the
level as a test of
kidneys
kidney function.

21
 BLOOD URIC 9.8 (H) 3.40-7.00 high levels of uric
ACID mEq/L acid, it can be a sign
of disease such
as gout. That’s when
you might need a
uric acid blood test,
which measures
how much uric acid
you have in your
blood.

CLINICAL CHEMISTRY II
DATE TEST RESULT REFERENCE INTERPRETATION SIGNIFICANCE
VALUES
An enzyme
The result is above the required during
July LDH 427.7 135.00- normal range. High level the process of
18,2018 225.00 U/L of LDH may indicate a
Lactate turning sugar
Dehydrogenase number of conditions. into energy for
Elevated levels of LDH your cells. LDH
can include: blood flow
is present in
deficiency,
many kinds of
cerebrovascular
accident, also known as organs and
a stroke certain cancer, tissues
heart attack, hemolytic throughout the
anemia, infectious body, including
mononucleosis, liver the liver, heart,
disease, such as pancreas,
hepatitis, muscle injury, kidneys, skeletal
muscular dystrophyy, muscles, lymph
pancreatitis, tissue tissue, and
death, use of alcohol or blood cells.
certain drugs, sepsis and
septic shock.

22