Leukemia

Pathophysiology

A mutation in bone marrow stem cells causes overproduction of nonfunctioning leukocytes
Crowding effect: Malignant cells displace functional erythrocytes, healthy leukocytes, and thrombocytes
Classified by speed: acute (immature "blasts") vs. chronic (mature but nonfunctioning cells)
Classified by cell line: lymphocytic vs. myelogenous — four combinations (ALL, AML, CLL, CML)
Philadelphia chromosome: Found in >90% of CML cases
Untreated cases typically result in death from excessive bleeding or overwhelming infection

Profound fatigue, low stamina, shortness of breath (secondary anemia from displaced RBCs)
Easy bruising (ecchymosis) and prolonged bleeding from minor cuts (thrombocytopenia)
Petechiae (pinpoint spots) and purpura (purple patches) — direct evidence of dangerously low platelets
Recurrent bacterial or viral infections (neutropenia)
Deep bone pain and joint tenderness (subperiosteal infiltration and marrow expansion)
Painless swelling of lymph nodes and abdominal fullness (splenomegaly/hepatomegaly)
Pale skin, gums, and nail beds. Ashy-gray color in dark skin

Petechiae and purpura: Direct evidence of dangerously low platelet count — modify pressure immediately
Fever: Systemic contraindication for massage
Splenomegaly (upper left quadrant tenderness): Risk of splenic injury — avoid deep abdominal work
Leukostasis: Extremely high blast count (>100,000 cells/uL) makes blood viscous, predisposing to leukoblastic emboli
Tumor lysis syndrome: Medical emergency during initial chemotherapy — coordinate with medical team
Blasts >20% in bone marrow biopsy: Diagnostic criterion for acute leukemia

Central risks: Clients are extremely vulnerable to bruising (low platelets), bleeding, and infection (neutropenia)
Systemic contraindication: Rigorous circulatory massage is contraindicated during acute phases or while febrile
Therapeutic role: Gentle, noninvasive touch is valuable for managing pain, anxiety, and sleep disturbances
Platelet precaution: If platelets are below 20,000, use pressure no greater than "applying lotion"
Tumor lysis syndrome: Massive necrosis of malignant cells during initial chemo can cause life-threatening renal failure
Hygiene standard: Severely immunocompromised. Strict IPAC protocols. Postpone if therapist has any active illness
Treatment side effects: See chemotherapy and radiation-therapy

Classify by speed (acute vs. chronic) and cell line (lymphocytic vs. myelogenous)
Petechiae and purpura are direct evidence of dangerously low platelet count
Fever is a systemic contraindication
Splenomegaly indicates organ involvement and splenic injury risk
Philadelphia chromosome is associated with CML
Blasts >20% in bone marrow biopsy is diagnostic for acute leukemia

Leukemia involves overproduction of nonfunctioning WBCs that crowd out healthy blood cells, causing anemia, bleeding, and infection vulnerability
Rigorous circulatory massage is systemically contraindicated during acute phases. Gentle touch is appropriate for palliative care
If platelets are below 20,000, pressure should be no more than "applying lotion"
The therapist must not carry active pathogens into the session due to severe immunocompromise
Philadelphia chromosome is found in >90% of CML cases. Tumor lysis syndrome is a medical emergency during initial chemotherapy