Problem description:
My mother is 73 years old. A month ago, she was admitted to the hospital with a headache caused by diabetes and hyperglycemia. But now she has no headache. On the contrary, her whole body aches, especially her waist and ribs. The pain is unbearable. She had a general examination and found hydronephrosis, gastritis, fatty liver, pneumonia and intestinal obstruction. The doctor said it was a complication of diabetes, but it was actually inflammation. Except for not having a bone marrow puncture. What is the cause of the whole body pain?
Analysis:
clinical picture
1, the onset of leukemia is sudden or slow, and many children and adolescents have sudden onset. Common initial symptoms include: fever, progressive anemia, obvious bleeding tendency or joint pain. The chronic patients are mostly the elderly and some young patients, and their condition is gradually progressing. The first symptoms of these patients are progressive fatigue, pale face, palpitation and shortness of breath after fatigue, loss of appetite, weight loss or fever of unknown origin. In addition, a few patients may have convulsions, blindness, toothache, swollen gums, pericardial effusion and paraplegia of both lower limbs as the first symptoms.
2. Fever and infection
First, fever is one of the most common symptoms of leukemia, which can appear in different stages of recurrence, with different degrees of fever and heat type. The main cause of fever is infection, among which angina, stomatitis and perianal inflammation are the most common, and pneumonia, tonsillitis, gingivitis and perianal abscess are also very common. Ear inflammation, enteritis, carbuncle, pyelonephritis and so on. It can also be seen that sepsis and septicemia can also occur in severe infections.
B. Bacteria are the most common infectious pathogens, and Gram-positive cocci are the main pathogens in the early stage of the disease. Although virus infection is rare, it is often dangerous. Cytomegalovirus, measles or varicella virus infection is prone to pneumonia, which should be paid attention to.
3, bleeding bleeding is also a common symptom of leukemia, bleeding sites can be all over the body, with skin, gums, nasal bleeding being the most common, and retinal and ear bleeding and visceral bleeding such as intracranial, digestive tract and respiratory tract can also occur. Menstruation is also common in women and can be the first symptom. M3 and M5 subtype AML bleeding is more serious, especially M3 patients are more likely to die of disseminated intravascular coagulation (DIC) and intracranial hemorrhage.
4. Anemia can occur in the early stage, and a few cases can appear refractory anemia months or years before diagnosis, and then develop into leukemia. Patients are often accompanied by fatigue, pallor, palpitation, shortness of breath, edema of lower limbs and other symptoms. Anemia can be seen in all types of leukemia, but it is more common in elderly AML patients, and many patients often take anemia as the first symptom.
5, signs of leukemia cell infiltration
First, hepatomegaly, splenomegaly and lymphadenopathy
B, nervous system: The main pathological changes are bleeding and leukemia infiltration.
C. Bone and joint: Bone and joint pain is one of the important symptoms of leukemia, and ALL is more common.
D, skin; There are two kinds of skin lesions: specific and nonspecific. The former is characterized by maculopapules, pustules, lumps, nodules, erythroderma, exfoliative dermatitis and so on. This is more common in adult monocytic leukemia, which manifests as ecchymosis and spots on the skin.
E. oral cavity: gingival swelling, bleeding and leukemia infiltration are common in AML-M5. In severe cases, the entire gum can be extremely proliferated, swollen like a sponge, and the surface is prone to bleeding.
F. Heart: mostly manifested as myocardial leukemia infiltration, hemorrhage, epicardial hemorrhage and pericardial effusion.
G. Kidney: More than 40% leukemia patients have kidney disease.
H, gastrointestinal system: manifested as nausea and vomiting, loss of appetite, abdominal distension, diarrhea, etc.
1. Lung and pleura: It mainly infiltrates alveolar wall and lung space, but also infiltrates bronchi, pleura and blood vessel wall.
J, others: uterus, ovary, testis, prostate, etc. Can be infiltrated by white blood cells. Female patients often have bleeding and menstrual cycle disorder. Male patients may have a * * * decline.
diagnostic criteria
1, the clinical symptoms are sudden high fever, progressive anemia or significant bleeding, general aches and fatigue.
2, signs of skin bleeding, sternal tenderness, lymphadenopathy, hepatosplenomegaly.
3. Laboratory:
A, blood white blood cells are always significantly increased (or decreased), and primitive or naive cells may appear.
B, bone marrow-like nucleated red blood cells account for less than 50% of all nucleated cells, and the original cells are ≥30%, which can be diagnosed as acute leukemia; If the nucleated red blood cells in bone marrow are ≥50% and the proportion of primitive cells in non-erythroid cells is ≥30%, it can be diagnosed as acute erythroleukemia.
Differential diagnosis:
A, aplastic anemia;
B, myelodysplastic syndrome;
C, malignant histiocytosis;
D, idiopathic thrombocytopenic purpura
Leukemia is a malignant disease of hematopoietic system. Leukemia cells are transformed from granulocytes, erythrocytes, megakaryocytes, lymphocytes and monocytes of hematopoietic system.
According to leukemia theory, leukemia is formed by the continuous proliferation and development of the first mutated stem cells. It is generally believed that leukemia cells can be detected in patients' blood when malignant cells proliferate to the level of109 ~1kloc-0/1.
Leukemia cells, like other tumor cells, have abnormal morphology, metabolism and function. Its growth is extremely vigorous, and it has lost its ability to differentiate and mature and its corresponding functions. The difference is that a single leukemia cell is often indistinguishable from normal hematopoietic cells at the same stage under the light microscope, and its malignant characteristics are not as obvious as those of solid tumor (cancer or sarcoma) cells.
On the other hand, leukemia cells have greater dispersion or migration ability than solid tumor cells, and enter the blood earlier and infiltrate other organs and tissues. Generally, solid, localized masses or space-occupying lesions do not form, and white sarcoma or green tumor (granulocytic sarcoma) can form in a few cases.
Leukemia cells are caused by pathogenic factors, such as differentiation disorder and maturation arrest. If the granulocyte stagnates in the primitive stage, it is primitive myeloid leukemia; If it stays at the promyelocytic stage, it becomes acute promyelocytic leukemia; If it stays at a more mature stage, it is chronic leukemia.
At present, the mortality rate of leukemia is decreasing year by year. The cure rate of acute lymphoblastic leukemia is over 95%, and the possibility of cure without recurrence for five consecutive years is about 70-80%. Combined with different types of leukemia, the cure rate should be around 60%.
What should leukemia patients pay attention to when taking nutrition and diet?
1, high protein
Leukemia is caused by pathological changes of blood cells. The consumption of protein in these patients is much higher than that in normal people. Only by supplementing protein with high quality can the functions of various tissues and organs be maintained. Another function of protein is to form antibodies, which can protect the body from bacteria and viruses and improve the body's resistance. Therefore, leukemia patients should adopt a high-protein diet, especially choose some animal proteins and bean proteins with good quality and high digestion and absorption rate, such as eggs, milk, fish and shrimp, lean meat, animal blood, animal offal, tofu, tofu, yuba, soybean milk and so on. To supplement the body's demand for protein.
The liver is rich in protein, vitamins and important minerals. Every 100g liver contains protein 2 1.3g, which is 35% higher than lean meat and 30% higher than eggs. Animal liver is also rich in trace elements such as iron, selenium and copper. In addition, the liver also contains more nucleic acids, which has a potential role in preventing cancer. Eating some animal liver in daily diet is of great benefit to leukemia patients.
2. Eat more foods rich in vitamins.
Clinical data prove that about 70 ~ 90% of patients with malignant tumors have vitamin deficiency in different degrees. Foreign medical research has proved that eating more vegetables and fruits rich in vitamin C can prevent the formation and spread of cancer cells. Taking a large amount of vitamin C can also enhance the local matrix resistance and immune function of the whole body, thus achieving the purpose of controlling and treating cancer. Foods rich in vitamin C include rape, potherb mustard, tomato, small white radish, leek radish, leek radish, hawthorn, citrus, fresh dates, macaques, seabuckthorn and lemon.
Vitamin A can stimulate the immune system, arouse the anti-cancer enthusiasm and resist the invasion of pathogenic substances. Foods rich in vitamin A include carrot, pumpkin, egg yolk, animal liver, cod liver oil, alfalfa, sweet pepper and pineapple.
3. Eat more foods rich in iron.
Anemia is one of the main manifestations of leukemia, so patients are encouraged to eat some foods rich in iron, such as animal liver, blood, soft-shelled turtle, peas, black beans, green vegetables, jujube, brown sugar, black fungus, sesame sauce, egg yolk and so on.
In recent years, some people have tried to treat malignant tumors with goose blood and achieved certain results. Leukemia patients should often eat goose blood. There are many ways to eat goose blood, which can be adjusted according to your own taste.
4, eat less and eat more, easy to digest
Leukemia patients, especially during chemotherapy, often have many symptoms of digestive system, such as nausea, vomiting, abdominal distension, diarrhea and so on. At this time, you can take the method of eating less and eating more meals, or supplement some small, high-calorie and nutritious foods besides three meals, such as cake, chocolate, bread, quail eggs, fish floss, yogurt, kiwi fruit, fresh vegetable juice and so on.
5. Adjust your diet according to your illness.
If the patient has poor appetite and indigestion, semi-liquid or soft rice can be provided, such as rice porridge, porridge at the end of liver, steamed egg soup, yogurt, tofu, steamed bread and so on. , can also be supplemented by hawthorn, radish and other foods.
In short, leukemia patients need to be given a diet with high calorie, high protein, rich in vitamins and minerals, which is easy to digest due to hypermetabolism, so as to supplement the consumption of calories and various nutrients in the body. Especially during chemotherapy, patients often have digestive tract reactions such as loss of appetite, abdominal distension, diarrhea, nausea and vomiting. Attention should be paid to the color, aroma, taste and shape of dishes to arouse patients' appetite.
Matters needing attention in life of leukemia patients
2 1 century is an era that pays attention to the quality of life, and leukemia patients are no exception. Patients with chronic myeloid leukemia should pay more attention to self-care and nursing while insisting on drug treatment because of their poor body resistance and immunity.
Stay optimistic and actively cooperate with the treatment.
Before 1970s, leukemia was considered as an incurable disease, and once became synonymous with death. However, today, people are no longer afraid and helpless about leukemia, because people have mastered the weapons to contain or even defeat leukemia.
A good mood can improve the body's resistance to cancer cells, which is irreplaceable by any medicine. It is very important to maintain an optimistic mood, a good mental state and actively cooperate with treatment for self-rehabilitation.
Pay attention to food hygiene and arrange the diet reasonably.
Patients with leukemia should pay attention to food hygiene in daily life and avoid eating cold, overnight or spoiled food; Fresh fruit must be washed and peeled before eating; Some fried or hard foods should also be avoided; For habitual constipation before illness, attention should be paid to supplementing foods rich in cellulose and eating less spicy food; Try to keep the daily defecation unobstructed, prevent constipation from aggravating hemorrhoids or inducing anal fissure, and increase the chance of local infection.
Choose protein with good quality and easily digestible animal proteins and beans, such as eggs, milk, fish and shrimp, lean meat, tofu and soybean milk. , to supplement the body's demand for protein.
Eat more foods rich in vitamins, such as tomatoes, kiwis and lemons rich in vitamin C; Foods rich in vitamin A, such as carrots, pumpkins, egg yolks and cod liver oil, can enhance the local resistance and systemic immune function of the human body. In addition, eat more foods containing iron.
Moderate physical exercise is also important.
Patients with chronic myeloid leukemia in acute phase, especially those complicated with fever, anemia, bleeding or chemotherapy, should stay in bed. During the remission period, you can do what you can according to your own situation, but you should avoid too intense exercise.
Walking is a good exercise for leukemia patients, but avoid going to crowded places and wear a mask if necessary. Besides walking often, you can also play Tai Ji Chuan and climb stairs.
Prevent bleeding and infection
Patients with leukemia should keep their skin clean, bathe frequently and change their underwear frequently. Pay attention to oral hygiene, rinse your mouth before and after meals, and brush your teeth with a soft toothbrush; Wash after defecation; Protect the skin mucosa and prevent bleeding and infection caused by trauma; Try not to pick your ears or teeth with hard objects.