Different Types of leukemia
Chronic
Lymphcytic
Leukemia
Incidence Who it affects?
25-40%
Prognosis
Over age 55 Average 6 yr. survival
Causes
-change in lymphocyte
-chromosomal abnormality
-slow accumulation of
CLL lymphocytes
Other
Chronic
Myeloid
Leukemia
Acute
Lymphocytic
Leukemia
Acute
Myeloid
Leukemia
Hairy Cell
Leukemia
15-20%
20%
20%
5,200 new cases each year
Adults
Most often in children under 15.
Risk increases over 45
Both adults and children
Rare type of chronic leukemia
Poor. Average
3-4 year survival.
Adults: poor
Children: 60% survival with treatment
Poor even with treatment. 10-
15% survival
-have a ‘Philadelphia
Chromosome’ or Ph chromosome- a switch in pieces 9 and 22
-change to single cell in bone marrow
-Chromosomal abnormality
-Environmental factors
-Down Syndrome
-Genetic
-Change to single cell in bone marrow
No cure for CLL
-S&S develop slowly
-need a blood test to make Dx
-may want to get 2 nd opinion
-may want to get a 2 nd opinion
-Three phases (Chronic, accelerated, blast crisis)
-children are likely to be cured
-more adults have remissions and length of remission has increased
Goal is to bring about remission or cure the disease
What makes all types of Leukemias the same?
 Cancer of the hematologic system (abnormal multiplication of WBC precursors)
 Does not METASTASIZE
 Causes symptoms throughout the body
 High doses of radiation and high doses of benzene are risk factors
 Common signs and symptoms o Enlarged lymph nodes o Unusual bleeding o Prolonged menstruation o Easy bruising o Fatigue o Dyspnea o Weight loss and loss of appetite o Fevers and sweats o Pale skin
 Medical Management o Chemotherapy o Hematologists and oncologists
 Focus of Physical Therapy Treatment o Keep patients feeling well enough to carry on day to day activities

Differential Diagnosis in children
Red Flags

Insidious onset – can occur with kids, they fall a lot

Symptoms unrelieved by PT

Significant weight loss/gain >10% in 10-21 days

Symptoms seem out of proportion to the injury

Symptoms persist beyond the expected time for that condition

Unable to alter/provoke symptoms during exam
 Doesn’t fit expected mechanical or neuromuscular pattern

NIGHT PAIN

BRUISING
– s/s of Leukemia
Kids with antalgic gait: (Campbell p. 495-500)

Legg-Calve-Perthes disease – avascular necrosis of the femoral head (more common in boys), would have limited hip ROM

Discoid lateral meniscus
– pain, locking, clicking of the knee, giving way, limp;

Sever Disease – calcaneal apophysitis, caused by trauma: heel pain

Growing pains – is a diagnosis of exclusion, usually bilateral aching in legs, usually at night and after very active days. Symptoms usually relieved by tyenol and massage.
Kids with joint swelling

Presents like juvenile rheumatoid arthritis

Can be due to leukemia – kids with ALL often present like JRA, o Can be due to involvement of synovium or leukemic arthritis (5% of kids with leukemia develop this type of arthritis)
KIDS WITH BRUISING
Physical abuse: (Campbell p.1133-1134)

s/s – bony fractures, soft tissue injuries, burns, hematomas, welts, internal injuries, contusions

X-rays will often show multiple fractures of different ages

It is not the job of the PT to do the differential diagnosis of child abuse. It is the responsibility of the PT if they suspect abuse to contact authorities and possibly refer back to the physicians with your suspicions.
Leukemia

Easy bruising is a symptom