Leukemia

Leukemia begins in the blood-forming tissues, usually the bone marrow. Abnormal precursor cells multiply and may enter the bloodstream, while normal production of red blood cells, functional neutrophils, and platelets falls. That single marrow problem creates three bedside patterns: reduced oxygen delivery causes fatigue and dyspnea; impaired host defence makes infection—especially fever—dangerous; and thrombocytopenia produces bruising or bleeding. A high white-cell count does not reassure you, because leukemic cells may be immature or ineffective. Acute leukemias can progress rapidly and may cause marrow failure, leukostasis, tumour lysis syndrome, or coagulopathy. Chronic leukemias often follow a slower course, although an individual client can still deteriorate. The RPN is not expected to determine the subtype independently. The clinical task is to recognize the blood-cell problem, identify the emergency pattern, provide safe predictable care, and escalate changes promptly.