Leukemia
What is leukemia?
Leukemia is a cancer that starts in the stem cells of the bone marrow that make
blood cells. Bone marrow is the soft, spongy material that fills the centre of most
bones (where blood cells are made). Blood stem cells (immature blood cells)
develop into either myeloid stem cells or lymphoid stem cells.
Myeloid stem cells develop into one of three types of mature blood cells:

Red blood cells carry oxygen to all tissues of the body.

Platelets form clots in damaged blood vessels to prevent bleeding.

White blood cells called granulocytes and monocytes destroy bacteria and
help to fight infection.
Lymphoid stem cells develop into lymphocytes. Lymphocytes are another type of
white blood cell that is usually found in the lymph nodes and lymphatic system,
such as the spleen and the blood. Lymphocytes make antibodies to help fight
infection.
Leukemia develops when the blood stem cells in the bone marrow make
abnormal blood cells. These abnormal cells are called leukemia cells. Over time,
the leukemia cells crowd out normal blood cells. This makes it hard for the white
blood cells, red blood cells and platelets to do their jobs
Symptoms of leukemia
Symptoms start to appear as the number of leukemia cells grows and your bone
marrow can no longer make the normal blood cells your body needs. Having too
few normal white blood cells, red blood cells or platelets can cause a number of
symptoms. In acute leukemia, symptoms appear and get worse quickly.
Acute leukemia (AML and ALL) can cause you to have too few normal white blood
cells (a condition called neutropenia). You will not be able to fight infection very
well. If you have too few red blood cells (anemia), you may feel very tired, be
short of breath or look pale. Too few platelets (thrombocytopenia) can lead to
unusual bleeding. You may bruise easily or notice small purple or red spots on
your skin, especially on your arms and legs. Other general symptoms of acute
leukemia may include:

fever

unexplained weight loss

general discomfort

sore throat

swollen gums

drenching night sweats

headache

vomiting

vision problems

bone or joint pain

painless swelling of the lymph nodes
In the early stages of chronic leukemia (CML and CLL), the leukemia cells can
function almost normally and cause no symptoms. The disease is often discovered
during a routine blood test. When symptoms do appear, they generally are mild
at first and get worse gradually. General symptoms of chronic leukemia may
include:

fatigue

general discomfort

loss of appetite

unexplained weight loss

drenching night sweats

painless swelling of the lymph nodes
Often, these symptoms are not caused by leukemia. Other health problems can
cause them, such as the flu or an infection. Testing is needed to make a diagnosis.
Treatment for leukemia
Chemotherapy
Chemotherapy may be given as pills or by injection. Chemotherapy drugs
interfere with the ability of cancer cells to grow and spread, but they also damage
healthy cells. Although healthy cells can recover over time, you may experience
side effects from your treatment like nausea, vomiting, loss of appetite, fatigue,
hair loss and an increased risk of infection.
Stem cell transplant
Sometimes high doses of chemotherapy are used to treat leukemia that has come
back or if there is a high risk that it may come back. High-dose chemotherapy
destroys the bone marrow cells as well as the leukemia cells, so the bone marrow
will need to be replaced with a transplant of stem cells. All blood cells develop
from stem cells found in the bone marrow and in the bloodstream.
Before high-dose chemotherapy is given, stem cells will be taken from you or
from a donor whose bone marrow is a close match to your own. Soon after the
chemotherapy treatment, the stem cells are put back into your blood. Within a
few weeks, the new stem cells will start to make blood cells.
A stem cell transplant is a very and complex procedure. For this reason, stem cell
transplants are done in specialized transplant centres or hospitals by a team of
highly trained healthcare professionals. Side effects can be very serious and may
even be life-threatening. You will be watched very closely after a stem cell
transplant and carefully followed up for a period of time after leaving the
hospital. It may take several months to fully recover after a stem cell transplant.
Radiation therapy
In external beam radiation therapy, a large machine is used to carefully aim a
beam of radiation. The radiation damages the cells in the path of the beam –
normal cells as well as cancer cells. Radiation side effects will be different
depending on what part of the body receives the radiation. You may feel more
tired than usual, have some diarrhea, or notice changes to the skin (it may be red
or tender) where the treatment was given.
Radiation may be used for some types of leukemia to treat the disease or prevent
it from spreading. If you need a stem cell transplant, you may also be given
radiation to the whole body to destroy the bone marrow cells. This is called total
body irradiation.
From the Canadian Cancer Society
http://www.cancer.ca/Canadawide/About%20cancer/Types%20of%20cancer/Wh
at%20is%20leukemia.aspx#ixzz2KcvGRgpy
Anemia
(From: http://www.mayoclinic.com)
Definition
By Mayo Clinic staff
Anemia is a condition in which you don't have enough healthy red blood cells to
carry adequate oxygen to your tissues. Having anemia may make you feel
exhausted.
There are many forms of anemia, each with its own cause. Anemia can be
temporary or long term, and it can range from mild to severe.
See your doctor if you suspect you have anemia, because anemia can be a sign of
serious illnesses. Treatments for anemia range from taking supplements to
undergoing medical procedures. You may be able to prevent some types of
anemia by eating a healthy, varied diet.
Symptoms
By Mayo Clinic staff
Signs and symptoms vary depending on the cause of your anemia, but may
include:

Fatigue

Pale skin

A fast or irregular heartbeat

Shortness of breath

Chest pain

Dizziness

Cognitive problems

Cold hands and feet

Headache
Initially, anemia can be so mild it goes unnoticed. But signs and symptoms
increase as anemia worsens.
When to see a doctor
Make an appointment with your doctor if you're feeling fatigued for unexplained
reasons. Some anemias, such as iron deficiency anemia, are common. Fatigue has
many causes besides anemia, so don't assume that if you're tired, you must be
anemic.
Some people learn that their hemoglobin is low, which indicates anemia, when
they go to donate blood. Low hemoglobin may be a temporary problem remedied
by eating more iron-rich foods or taking a multivitamin containing iron. However,
it may also be a warning sign of blood loss in your body that may be causing you
to be deficient in iron. If you're told that you can't donate blood because of low
hemoglobin, make an appointment with your doctor
Treatments and drugs
By Mayo Clinic staff
Anemia treatment depends on the cause:

Iron deficiency anemia. This form of anemia is treated with changes in your
diet and iron supplements. If the underlying cause of iron deficiency is loss
of blood — other than from menstruation — the source of the bleeding
must be located and stopped. This may involve surgery.

Vitamin deficiency anemias. Folic acid deficiency anemia is treated with
folic acid supplements. If your digestive system has trouble absorbing
vitamin B-12 from the food you eat, you may receive vitamin B-12
injections.

Anemia of chronic disease. There's no specific treatment for this type of
anemia. Doctors focus on treating the underlying disease. If symptoms
become severe, a blood transfusion or injections of synthetic
erythropoietin, a hormone normally produced by your kidneys, may help
stimulate red blood cell production and ease fatigue.

Aplastic anemia. Treatment for this anemia may include blood transfusions
to boost levels of red blood cells. You may need a bone marrow transplant
if your bone marrow is diseased and can't make healthy blood cells.

Anemias associated with bone marrow disease. Treatment of these
various diseases can range from simple medication to chemotherapy to
bone marrow transplantation.

Hemolytic anemias. Managing hemolytic anemias includes avoiding
suspect medications, treating related infections and taking drugs that
suppress your immune system, which may be attacking your red blood
cells. Short courses of treatment with steroids or immune suppressant
medications can help suppress your immune system's attack on your red
blood cells. Depending on the severity of your anemia, a blood transfusion
or plasmapheresis may be necessary. Plasmapheresis is a type of bloodfiltering procedure.

Sickle cell anemia. Treatment for this anemia may include the
administration of oxygen, pain-relieving drugs, and oral and intravenous
fluids to reduce pain and prevent complications. Doctors may also
recommend blood transfusions, folic acid supplements and antibiotics. A
bone marrow transplant may be an effective treatment in some
circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is
used to treat sickle cell anemia.
Hemophilia
What Is Hemophilia?
Hemophilia (heem-o-FILL-ee-ah) is a rare bleeding disorder in which the blood
doesn't clot normally.
If you have hemophilia, you may bleed for a longer time than others after an
injury. You also may bleed inside your body (internally), especially in your knees,
ankles, and elbows. This bleeding can damage your organs and tissues and may be
life threatening.
Overview
Hemophilia usually is inherited. "Inherited” means that the disorder is passed
from parents to children through genes.
People born with hemophilia have little or no clotting factor. Clotting factor is a
protein needed for normal blood clotting. There are several types of clotting
factors. These proteins work with platelets (PLATE-lets) to help the blood clot.
Platelets are small blood cell fragments that form in the bone marrow—a spongelike tissue in the bones. Platelets play a major role in blood clotting. When blood
vessels are injured, clotting factors help platelets stick together to plug cuts and
breaks on the vessels and stop bleeding.
The two main types of hemophilia are A and B. If you have hemophilia A, you're
missing or have low levels of clotting factor VIII (8). About 9 out of 10 people who
have hemophilia have type A. If you have hemophilia B, you're missing or have
low levels of clotting factor IX (9).
Rarely, hemophilia can be acquired. "Acquired” means you aren't born with the
disorder, but you develop it during your lifetime. This can happen if your body
forms antibodies (proteins) that attack the clotting factors in your bloodstream.
The antibodies can prevent the clotting factors from working.
This article focuses on inherited hemophilia.
Outlook
Hemophilia can be mild, moderate, or severe, depending on how much clotting
factor is in your blood. About 7 out of 10 people who have hemophilia A have the
severe form of the disorder.
People who don't have hemophilia have a factor VIII activity of 100 percent.
People who have severe hemophilia A have a factor VIII activity of less than
1 percent.
Hemophilia usually occurs in males (with rare exceptions). About 1 in 5,000 males
are born with hemophilia each year.
What Are the Signs and Symptoms of Hemophilia?
The major signs and symptoms of hemophilia are excessive bleeding and easy
bruising.
Excessive Bleeding
The extent of bleeding depends on how severe the hemophilia is.
Children who have mild hemophilia may not have signs unless they have excessive
bleeding from a dental procedure, an accident, or surgery. Males who have
severe hemophilia may bleed heavily after circumcision.
Bleeding can occur on the body's surface (external bleeding) or inside the body
(internal bleeding).
Signs of external bleeding may include:

Bleeding in the mouth from a cut or bite or from cutting or losing a tooth

Nosebleeds for no obvious reason

Heavy bleeding from a minor cut

Bleeding from a cut that resumes after stopping for a short time
Signs of internal bleeding may include:

Blood in the urine (from bleeding in the kidneys or bladder)

Blood in the stool (from bleeding in the intestines or stomach)

Large bruises (from bleeding into the large muscles of the body)
Bleeding in the Joints
Bleeding in the knees, elbows, or other joints is another common form of internal
bleeding in people who have hemophilia. This bleeding can occur without obvious
injury.
At first, the bleeding causes tightness in the joint with no real pain or any visible
signs of bleeding. The joint then becomes swollen, hot to touch, and painful to
bend.
Swelling continues as bleeding continues. Eventually, movement in the joint is
temporarily lost. Pain can be severe. Joint bleeding that isn't treated quickly can
damage the joint.
Bleeding in the Brain
Internal bleeding in the brain is a very serious complication of hemophilia. It can
happen after a simple bump on the head or a more serious injury. The signs and
symptoms of bleeding in the brain include:

Long-lasting, painful headaches or neck pain or stiffness

Repeated vomiting

Sleepiness or changes in behavior

Sudden weakness or clumsiness of the arms or legs or problems walking

Double vision

Convulsions or seizures
How Is Hemophilia Treated?
Treatment With Replacement Therapy
The main treatment for hemophilia is called replacement therapy. Concentrates
of clotting factor VIII (for hemophilia A) or clotting factor IX (for hemophilia B) are
slowly dripped or injected into a vein. These infusions help replace the clotting
factor that's missing or low.
Clotting factor concentrates can be made from human blood. The blood is treated
to prevent the spread of diseases, such as hepatitis. With the current methods of
screening and treating donated blood, the risk of getting an infectious disease
from human clotting factors is very small.
To further reduce the risk, you or your child can take clotting factor concentrates
that aren't made from human blood. These are called recombinant clotting
factors. Clotting factors are easy to store, mix, and use at home—it only takes
about 15 minutes to receive the factor.
You may have replacement therapy on a regular basis to prevent bleeding. This is
called preventive or prophylactic (PRO-fih-lac-tik) therapy. Or, you may only need
replacement therapy to stop bleeding when it occurs. This use of the treatment,
on an as-needed basis, is called demand therapy.
Demand therapy is less intensive and expensive than preventive therapy.
However, there's a risk that bleeding will cause damage before you receive the
demand therapy.
Home Treatment With Replacement Therapy
You can do both preventive (ongoing) and demand (as-needed) replacement
therapy at home. Many people learn to do the infusions at home for their child or
for themselves. Home treatment has several advantages:

You or your child can get quicker treatment when bleeding happens. Early
treatment lowers the risk of complications.

Fewer visits to the doctor or emergency room are needed.

Home treatment costs less than treatment in a medical care setting.

Home treatment helps children accept treatment and take responsibility for
their own health.
Discuss options for home treatment with your doctor or your child's doctor. A
doctor or other health care provider can teach you the steps and safety
procedures for home treatment. Hemophilia treatment centers are another good
resource for learning about home treatment (discussed in "Living With
Hemophilia”).
Doctors can surgically implant vein access devices to make it easier for you to
access a vein for treatment with replacement therapy. These devices can be
helpful if treatment occurs often. However, infections can be a problem with
these devices. Your doctor can help you decide whether this type of device is right
for you or your child.
Sepsis
From: http://www.emedicinehealth.com/sepsis_blood_infection/article_em.htm
Sepsis Overview
Sepsis is a condition in which the body is fighting a severe infection that has
spread via the bloodstream. If a patient becomes "septic," they will likely have
low blood pressure leading to poor circulation and lack of perfusion of vital
tissues and organs. This condition is termed "shock" and is sometimes referred to
as septic shock, when an infection is the cause of shock. This condition can
develop either as a result of the body's own defense system or from toxic
substances made by the infecting agent (such as a bacteria, virus, or fungus).
Sepsis Symptoms and Signs
If a person has sepsis, they often will have fever. Sometimes, though, the body
temperature may be normal or even low.
The individual may also have chills and severe shaking.
The heart may be beating very fast, and breathing may be rapid. Low blood
pressure is often observed in septic patients.
Confusion, disorientation, and agitation may be seen as well as dizziness and
decreased urination.
Some patients who have sepsis develop a rash on their skin. The rash may be a
reddish discoloration or small dark red dots seen throughout the body.
Those with sepsis may also develop pain in the joints of the wrists, elbows, back,
hips, knees, and ankles
Treatment
Sepsis is a medical emergency. If a person has sepsis, treatment is usually given in
the hospital and often in an intensive care unit.
The patient will likely be administered oxygen, either by a tube that is placed near
the nose or through a clear plastic mask.
Depending on the results of the tests, the doctor may order medications. These
medications may include antibiotics given intravenously (given directly into the
vein). Initially, the antibiotics may be those that kill many different bacteria
because the exact kind of infection the patient has is not known. Once the blood
culture results show the identity of the bacteria, the doctor may select a different
antibiotic that kills the specific organism responsible for the infection.
The doctor may also order IV salt solution (saline) and medications to increase the
blood pressure if it is too low.
Your health care professional will likely admit the patient to the hospital at least
until the blood culture results are known. If the patient is very ill and with low
blood pressure, the doctor may admit the patient to the intensive care unit (ICU)
and may consult specialist doctors to help in the management of the illness.
If results show an infection in the abdomen, either drainage of the infection by
the placement of tubes or surgery may be necessary.
Research to discover new treatments for sepsis has failed over the past 20-30
years. Many medications that were thought to be helpful were proven to have no
benefit in clinical trials. However, scientists are working diligently to discover
medications that will modify the body's aggressive immune response to microbes,
which leads to sepsis.
Malaria
(From: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001646)
Malaria is a parasitic disease that involves high fevers, shaking chills, flu-like
symptoms, and anemia.
Causes, incidence, and risk factors
Malaria is caused by a parasite that is passed from one human to another by the
bite of infected Anopheles mosquitoes. After infection, the parasites (called
sporozoites) travel through the bloodstream to the liver, where they mature and
release another form, the merozoites. The parasites enter the bloodstream and
infect red blood cells.
The parasites multiply inside the red blood cells, which then break open within 48
to 72 hours, infecting more red blood cells. The first symptoms usually occur 10
days to 4 weeks after infection, though they can appear as early as 8 days or as
long as a year after infection. The symptoms occur in cycles of 48 to 72 hours.
Most symptoms are caused by:

The release of merozoites into the bloodstream

Anemia resulting from the destruction of the red blood cells

Large amounts of free hemoglobin being released into circulation after red
blood cells break open
Malaria can also be transmitted from a mother to her unborn baby (congenitally)
and by blood transfusions. Malaria can be carried by mosquitoes in temperate
climates, but the parasite disappears over the winter.
The disease is a major health problem in much of the tropics and subtropics. The
CDC estimates that there are 300-500 million cases of malaria each year, and
more than 1 million people die from it. It presents a major disease hazard for
travelers to warm climates.
In some areas of the world, mosquitoes that carry malaria have developed
resistance to insecticides. In addition, the parasites have developed resistance to
some antibiotics. These conditions have led to difficulty in controlling both the
rate of infection and spread of this disease.
There are four types of common malaria parasites. Recently, a fifth type,
Plasmodium knowlesi, has been causing malaria in Malaysia and areas of
southeast Asia. Another type, falciparum malaria, affects more red blood cells
than the other types and is much more serious. It can be fatal within a few hours
of the first symptoms.
Symptoms

Anemia
Anemia is a condition in which the body does not have enough healthy red
blood cells. Red blood cells provide oxygen to body tissues.
Bloody stools

Chills

Coma

Convulsion
physical findings or changes in behavior that occur after an episode of
abnormal electrical activity in the brain.
The term "seizure" is often used interchangeably with "convulsion."
Convulsions are when a person's body shakes rapidly and uncontrollably.
During convulsions, the person's muscles contract and relax repeatedly.
There are many different types of seizures. Some have mild symptoms and
no body shaking

Fever

Headache

Jaundice
Jaundice is a yellow color of the skin, mucus membranes, or eyes. The

yellow coloring comes from bilirubin, a byproduct of old red blood cells.
Jaundice can be a symptom of other health problems.

Muscle pain

Nausea

Sweating

Vomiting
Treatment
Malaria, especially Falciparum malaria, is a medical emergency that requires a
hospital stay. Chloroquine is often used as an anti-malarial medication. However,
chloroquine-resistant infections are common in some parts of the world.
Possible treatments for chloroquine-resistant infections include:




The combination of quinidine or quinine plus doxycycline, tetracycline, or
clindamycin
Atovaquone plus proguanil (Malarone)
Mefloquine or artesunate
The combination of pyrimethamine and sulfadoxine (Fansidar)
The choice of medication depends in part on where you were when you were
infected.
Medical care, including fluids through a vein (IV) and other medications and
breathing (respiratory) support may be needed.