Follow up of children with leukemia

Patients who go into remission continue to be examined regularly by the doctor. Once the remission is induced and the therapy after it is completed, it is necessary to continue with a careful periodic evaluation of the patient's health status, make cell counts blood and, if necessary, bone marrow transplants. With the passage of time, the Evaluations can be made more spaced but should continue indefinitely.

While current therapy for acute lymphocytic leukemia can cure most children, the therapy can have long-term consequences, including effects on growth, psychological development and others. Because of these conceivable reactions, it is essential proceed long haul development and with long-term medical advice. Careful monitoring of children with known genetic abnormalities is important can increase your risk of developing leukemia, of those who have been treated by another type of cancer with chemotherapy, or with joined chemotherapy and radiotherapy, and the individuals who have gotten organ transplants and are taking suppressive medications of the immune system.

Efectivity cost

In pediatric patients with ALL in total abatement, a case-control ponder was directed to think about clinical and cost results between two medicines bone marrow transplantation 2. Utilization of fringe blood forebear cells (10 microgame/kg day for 4 back to back days. The clinical factors of result results were the quantity of passings, sickness free period at 100 days, 1 and 2 years and other antagonistic therapeutic results for the treatment; the result factors of the expenses were connected with the expense of anti-infection agents, transfusions of blood items, parenteral nourishment, research center examinations and x-beams, hospitalization time and others. The clinical finishes of the investigation were that treatment with fringe blood begetter cells is as sheltered as bone marrow transplant treatment and that patients who were treated with cells Peripheral blood ancestors recouped quicker and the restorative arrangements did not were more terrible than those treated with bone marrow transplant; The completions of the costs all around terms was that the cost of treatment with fringe blood forebear cells was superior to the treatment with bone marrow transplantation. (Madero L, 2000)

The utilization of granulocyte animating component to lessen the seriousness of neutropenia in kids who have gotten treatment with bone marrow transplant so as to diminish the danger of nosocomial contaminations. There are a couple of examinations that demonstrate the reasonability of the usage of the consider stimulant of granulocytes reestablishing neutrophil levels in grown-up patients. With this reason a non-randomized preliminary was directed with recorded controls to assess the adequacy of the utilization of granulocyte incitement factor in pediatric patients who had gotten 22 bone marrow transplant, one gathering got the granulocyte invigorating component and the control aggregate got standard consideration barring the granulocyte animating element. The factors of The outcome was the recuperation rate of neutrophils and the nonattendance of contaminations intrahospitalarias and tasteful high. The clinical ends were that there was no distinction in the outcomes in the two gatherings.

The authors concluded that there is no difference in the costs of treatment in the two groups, but the children who benefited from the stimulant factor got better quality of life for having achieved recover in less time neutrifilo levels what allowed these children to be removed earlier from isolation environments. (Duncan N, 1997)

Leukemia is characterized by having a clonal, autonomous and abnormal of the cells that give origin to the rest of the normal cells of the blood (tumor behavior in general). This implies that a cell early undergoes a genetic change that will cause an uncontrolled abnormal clone of itself. The cells abnormal multiply in image and likeness of themselves, so that occupy space gradually of normal bone marrow and cause Progressive anemia, abnormal bleeding and predisposition to infections. When abnormal cells invade other tissues, failure of the functioning of the organ that is occupied, for example, the infiltration to the system central nervous system that occurs in leukemia acute lymphoblastic could manifest with headache, seizures, alterations focused motor vehicles, increased intracranial pressure.

The cure of the condition will depend on the elimination of all existing malignant cells in the patient. In general, some of the leukemias can be susceptible to healing with chemotherapy only, but today it should be given much importance to the so-called prognostic factors that are based on mathematical models that allow locate patients in the degree of prognosis they have.

The alterations of the laboratory that force a special review include: 1. Anemia (any degree). 2. Leukopenia or leukocytosis (predominance of a Cellphone line). 3. Thrombocytopenia. 4. Combinations: bicytopenia or pancytopenia. Special care should be taken when the laboratory reports the presence of leukocytes or atypical lymphocytes (these may be leukemic blasts). It is advisable to request the review of an expert (figure 2). Bone marrow aspirate is essential for the diagnosis (figure 3) and the minimum of 20% of blasto to establish the criterion of acute leukemia in any of its variety. In the same procedure, samples should be obtained for the final classification of the condition and request karyotype and immunophenotype, since currently the cytomorphological criterion is Of vital importance but it is not enough anymore. In (Table 2) lists the current and current classification of malignant blood diseases.

The treatment is directed towards 2 important aspects: the first one is the specific anti-leukemia and is based on the use of drugs of chemical origin that are known with the name of chemotherapy, whose main objective is to eradicate, that is, eliminate all leukemic cells of the organism. The second aspect of the treatment is the support for the complications that patients usually present in their hospitalization, such as:

PSYCHOLOGICAL SUPPORT

What is a psycho-oncologist? A psycho-oncologist is a clinical psychologist specialized in the management both cancer patients and their relatives. Today there is a recognition explicit in that to achieve an optimal level of quality in attention to cancer patient is a must have adequate assistance psychological The health personnel of the oncology units, in addition to be subject to numerous sources of stress that arise daily, you see forced to face the psychosocial problems of patients and their families without having the necessary training. To cover this care, it is necessary to the services of a psycho-oncologist.

The diverse oncological plans created by the Administration They reflect among their suggestions the requirement for all oncology units to have something like one analyst. Additionally, the Comprehensive Cancer Plan, of the National Health System, gathers Chapter 10 The most vital deficiencies are the satisfactory psychosocial help of the patient and proposes among its gauges the requirement for incorporation of psychosocial support in the remedial arrangement.

Is it basic to get mental help?

Indeed. It has been known for a significant long time that the system of end and treatment of malignancy is joined by psychosocial issues in countless. The 47% of patients experience the ill effects of disarranges mental and mental specific consideration, and even, until the half of the individuals who don't meet criteria for be incorporated into any demonstrative class, show indications of worry in association with the procedure of your sickness.

The help work will be coordinated to both the patient and his family and will have as destinations: Improve the personal satisfaction of the patient and his adjustment and that of his family to both the medicines and the procedure of the ailment itself. Giving consideration from a more perspective humanist so as to lessen the effect of the elements accommodating in itself. Diminish the obligation of wellbeing work force to give mental help to the influenced nuclear family, in this way calming the heap of weight on the two sides.

In what cases?

As a rule, it tends to be said that all patients profit by help treatment, went for encouraging enthusiastic articulation and the board of the issues related with the oncological malady. The investigations have demonstrated that those patients who get this kind of treatment increment their capacity to tackle issues, to manage your negative considerations and sentiments, just as showing your feelings and not hinder them or stay away from them. This will immensely affect the individual fulfillment.

If I'm going to die, can you help me face the situation?

 I need to leave many things clarified and prepare my family for my absence Fortunately, breast cancer patients who can to find themselves in this situation are a minority; nevertheless, in oncology these problems arise with certain frequency. In our current society, where image, power, money and success prevail, There is room for death. You live with your back to a reality as intrinsic to man as your own life. On the other hand, in our culture Mediterranean, the protective effect of hiding bad news sick. Based on these two arguments and similar ones, it can be understood why in our clinical practice it is unusual for the doctor Focus in detail the palliative process and the proximity of death.

In the Anglo-Saxon countries, and especially in those of northern Europe, it is frequent that patients share their evolutions and forecasts until the end, preparing for the "last trip". The studies carried out by experts and our own experience show us that in these cases (as long as there is good symptomatic control and good level of consciousness) all are advantages when a patient waits death. Thus, the patient lives his last days in peace, with calm, with the tranquility of the duty fulfilled and, paradoxically, with total vital intensity, enjoying every minute.

He has also had time to resolve personal (economic, family, work) and spiritual issues. In our country it is frequent to inform the patient truthfully about his prognosis and even about the possibility of near death, but it's exceptional that a joint coping strategy be considered during this time. In principle, the patient does not feel prepared to demand that support and information since, despite the fact that he detects it, he wants to leave the snapshot of his conclusion to chance. Then again, the expert isn't typically arranged for this sort of coping, lacking in many times the involvement of a psychology unit.

Fortunately, with the current development in Spain of the Units of Palliative care, where there are multiprofessional teams, it is already possible to offer this type of support to all patients who need it.

ASPECTS TO REMEMBER

A psycho-oncologist is a clinical psychologist specialized in the management of both cancer patients and their family In general, it can be said that all patients advantage from strong treatment, went for encouraging the articulation passionate and the administration of the problems associated with the oncological disease. With the current development in Spain of the Units of Palliative care, where there are multiprofessional teams, it is already possible to offer this kind of support to all patients who need it.