Pulmonary Complications of Leukemia

Introduction

Leukemia, a form of blood cancer, brings about significant health challenges from the disease itself and the treatments. Leukemia can lead to various secondary health problems, with an increased chance of lung complications. The symptoms of the disease, along with the weakening of the immune system caused by both the disease and its treatment, can lead to damage to lung cells and the development of various lung diseases.

What Is Leukemia?

Leukemia is a kind of cancer that affects the blood cells forming organs like the bone marrow and lymphatic system. It involves the white blood cells, which help protect against pathogens. In leukemia, these white blood cells start growing and dividing too much, more than the body needs. In people with leukemia, the bone marrow makes a lot of abnormal white blood cells that do not work the way they should. There are different types of leukemia. Some are more common in kids, while others are seen more in adults. The symptoms of leukemia can vary depending on the type of leukemia. In some people, leukemia shows noticeable symptoms, but others may not experience any ongoing symptoms at all. Often, leukemia is found when a blood test is done for different health reasons, not specifically because of leukemia symptoms.

Some of the common signs and symptoms are

• Fever or chills.

• Weakness fatigue.

• Frequent infections.

• Sudden weight loss.

• Swollen lymph nodes.

• Enlarged spleen or liver.

• Easy bruising or bleeding.

• Recurrent nose bleed.

• Petechiae or tiny red spots in the skin.

• Bone pain or tenderness.

What Causes Pulmonary Complications in Leukemia?

Lung problems in leukemia can be linked to both the disease itself and the treatments used. The causes include

Infiltration of Leukemic Cells:

Pulmonary leukemic infiltrations happen when leukemia cells build up in the lungs. These infiltrations are considered a direct result of leukemia when there are no other problems like infections, bleeding in the lungs, or issues with blood vessels in the lungs. Under the microscope, they look like atypical lymphocytes gathered in the lung tissue.

These infiltrations can appear as thickened broncho vascular bundles and interlobular septa on imaging tests, but they might not look the same in every case. In regular X-ray images of the chest, most of the time, these infiltrations will not show up.

Lung Complications During Leukemia Induction Therapy:

Treatment for leukemia is divided into several phases, with the initial phase known as induction therapy. During this induction chemotherapy, a significant number of patients report lung-related issues. These complications include pulmonary edema and various lung infections.

The chemotherapy drugs used in this phase can weaken the immune system, making it harder for the body to defend against bacteria, viruses, and fungi. Individuals who were previous smokers or had pre-existing lung conditions are at a higher risk of experiencing lung problems during chemotherapy.

Stem Cell Transplantation and Associated Lung Complications:

Some individuals with leukemia may undergo a stem cell transplant, a treatment where high doses of chemotherapy or radiation therapy are used to eliminate the diseased cells in the bone marrow. This intense treatment can also harm healthy stem cells and needs the infusion of new stem cells to replace the damaged ones.

During stem cell transplant therapy, there is an increased risk of infections, which can occur within a few months of the procedure. Patients undergoing stem cell transplants may develop pulmonary hemorrhage and pulmonary edema, conditions that can damage lung cells and lead to associated complications.

Targeted Therapy and Lung Problems:

People with leukemia often receive targeted drug therapy, which is generally associated with fewer side effects than traditional chemotherapy. Patients using targeted therapies, such as tyrosine kinase inhibitors, may be at an increased risk of developing various lung problems like:

• Pleural Effusion: This condition involves the accumulation of fluid around the lungs, which can lead to discomfort and breathing difficulties.

• Pulmonary Hypertension: Some individuals may experience high blood pressure in the blood vessels of the lungs, a condition known as pulmonary hypertension.

• Interstitial Lung Disease: This condition can cause scarring within the lung tissue, hindering proper lung expansion and function.

• Pneumonia: Lung infections, like pneumonia, are another potential complication that individuals undergoing targeted drug therapy should be vigilant about.

What Are the Symptoms Associated With Leukemia and Lung Complications?

In leukemia patients who may have lung complications, signs of difficulty in breathing and unusual sensations in the chest can occur. Other common symptoms include

• Shortness of Breath: Feeling like one can not get enough air.

• Wheezing: A whistling or high-pitched sound when breathing.

• Cough: Persistent or unusual coughing.

• Fever: Elevated body temperature.

• Bluish Discoloration of Skin and Nails: A bluish tint to the skin or nails, especially on the lips and fingertips.

• Feeling Drowning or Suffocated: Sensation of suffocation or drowning.

• Pale Skin: Unusual paleness of the skin.

• Chest Pain: Discomfort or pain in the chest area.

How to Diagnose the Lung Complications Associated With Leukemia?

To diagnose pulmonary complications associated with leukemia, various tests are available. These tests include:

• Bronchoscopy: A procedure in which a thin, flexible tube with a camera is inserted into the airways to examine the lungs and collect samples if necessary.

• Bronchoalveolar Lavage: A technique that involves washing the lung's air sacs and collecting fluid for analysis, often done during a bronchoscopy.

• Lung Biopsy: Removal of a small sample of lung tissue for examination under a microscope to identify any abnormalities.

• CT Scan: Computed tomography (CT) imaging provides detailed cross-sectional pictures of the lungs, allowing for the detection of structural and functional issues.

How to Manage Lung Complications?

Patients experiencing lung complications require a range of supportive treatments. Here's how these issues can be managed:

• Symptomatic Treatment: Patients are provided with treatments to alleviate symptoms.

• Infections like Pneumonia: Infections are treated with various medications, including antibiotics and antiviral drugs.

• Fever or Pain: Analgesics and antipyretic medications are administered to reduce fever and pain.

• Chemotherapy: Patients undergoing chemotherapy should only take medications under the guidance of their doctor.

• Pulmonary Leukocytosis: In cases with an elevated number of white blood cells, doctors may recommend leukapheresis, a procedure in which a machine filters and removes excess white blood cells. Therapy drugs may also be used to regulate blood cell counts.

• Pulmonary Edema and Breathing Difficulty: Doctors may provide supplementary oxygen, often via a face mask or nasal cannula, to improve oxygen intake. Diuretic medications help remove excess fluid.

• Lifestyle Modifications: Adopting healthy habits, getting enough rest, staying hydrated, and avoiding smoking and exposure to secondhand smoke or campfire smoke. Steam therapy, such as taking a hot shower, drinking hot tea, or using a humidifier, can help open airways.

It is essential to consult with a healthcare professional for the best lifestyle modifications and home care tips if one is experiencing respiratory symptoms or lung complications associated with leukemia.

Conclusion

Pulmonary complications frequently accompany leukemia and its associated treatment strategies. Leukemia, along with its treatments, can weaken a patient's immune system, increasing the risk of infections. These factors can harm lung cells, leading to issues such as lung diseases, breathing difficulties, and even lung damage. Timely attention and effective management of these respiratory complications are important.