Leukemia is a hematopoietic malignancy with a very high mortality rate, and the vast majority of subtypes remain incurable. Compared to the treatment of other tumors, fewer new drugs have been developed for leukemia. The main treatment remains combination chemotherapy with cytotoxic drugs, which leads to a state of severe myelosuppression, including normal hematopoietic cells, due to the absence of specific killing targets, and adverse effects such as infection and bleeding accompany almost every chemotherapy treatment.
The normal value of white blood cells in routine blood tests is (4.0-10.0) × 10/L, with 2.0 × 10/L of neutrophils, which have an anti-infective effect. if the neutrophils are below normal, it is called granulocytopenia, and less than 0.5 × 10/L is granulocyte deficiency. The leukemia chemotherapy is basically followed by a granulocyte deficiency state, which is usually continued in the hospital for observation and treatment, and at the granulocytopenic stage (patients in remission usually about 2 weeks after chemotherapy) can be discharged for outpatient follow-up as appropriate, depending on infection control.
The longer the duration of post-chemotherapy leukopenia, the greater the threat of infection due to the underlying leukemia, especially in primary and relapsed refractory patients who have not yet achieved remission, and the effect of chemotherapy drugs on immune function. For protection, it is important to do the following:
Dietary guidance
- Eat a well-balanced and rational diet, rich in high-quality protein and vitamins, avoiding cold, irritating or fried foods;
- Follow the principle of small and frequent meals, do not overeat, and also prevent constipation and diarrhea, which aggravate the burden of the stomach and intestines.
Protective isolation
- Single patient rooms, or even laminar flow rooms, if available, should be used to avoid cross infection;
- General or single patient rooms need to have regular ultraviolet light exposure, limit the number of visitors and their frequency, and staff and visitors should wash their hands carefully before touching the affected child.
Pay attention to personal hygiene
- Keep the mouth clean and rinse with warm boiled water or oral tide before and after eating;
- It is advisable to use a soft-bristled toothbrush to avoid damage to the oral mucosa causing bleeding and secondary infection;
- For mucosal fungal infections, fluconazole or itraconazole can be applied to the affected area;
- Change your clothes and pants regularly and bathe daily to facilitate sweat excretion and reduce the occurrence of folliculitis and skin boils.
- Keep the bowels open and clean the anus with warm water or strong iodine dilution after defecation.
Observe for early signs of infection
- Check the mouth and throat daily for swollen gums, red throat, painful swallowing sensation, skin breakage, redness and swelling, abnormal changes in vulva and perianal area, etc., and treat the infection promptly when the precursors are found.
Medical aspects
- Staff must strictly implement aseptic technique and must be strictly sterilized before performing any puncture;
- Various tubes or wound dressings should be changed regularly to avoid bacterial growth;
- Two to three effective antibiotics can be used orally or intravenously for co-infection.
- Promote hematopoiesis with B vitamins, shark liver alcohol, and reserpine;
- For patients suitable for granulocyte colony-stimulating factor (G-CSF), appropriate doses and courses of treatment can shorten the duration of granulocyte deficiency, promote neutrophil proliferation and release, and enhance their chemotactic, phagocytic, and bactericidal functions.
Psychological care
- Patients with leukemia generally have a short course of disease, and the sudden physical and psychological fall can increase the psychological burden, often manifesting as an anxious and depressed state. In response to the psychological changes of patients, timely guidance should be provided so that they can understand the disease, understand the treatment process, establish confidence in recovery, and be able to better cooperate with treatment and care.