Madaris Linda
University of South Florida, Tampa, Florida, USA.
J Am Acad Nurse Pract. 2010 Dec;22(12):648-53. doi: 10.1111/j.1745-7599.2010.00566.x. Epub 2010 Nov 5.
To present a case report of an 83-year-old female with underlying dementia and a 1-2 month history of left upper quadrant pain. This report includes a review of the morphology of T-cell prolymphocytic leukemia (PLL), diagnosis, and the treatment options considered.
T-cell PLL is a rare blood disorder that represents a very small number of all chronic leukemias. An extensive review of scientific literature related to the cell morphology and pathology of this disease, as well as clinical trials of treatment options provided the background for this case report.
A diagnosis of T-cell PLL was made after a computed tomography scan of the abdomen confirmed splenomegaly and a bone marrow biopsy showed a hypercellular marrow infiltrated with numerous small lymphocytes, consistent with this disease. Currently, there is no optimal treatment for T-cell PLL, but alemtuzumab has shown success with extending survival 1-3 years.
This case presented several ethical and practical challenges for this patient and her family in making a decision for chemotherapy treatment. This case underscores the need for the physicians and nurse practitioners to establish a collaborative relationship with patient, family, and other care providers when advocating for or against treatment.
报告一例83岁患有潜在痴呆症且有1至2个月左上腹疼痛病史的女性病例。本报告包括对T细胞幼淋巴细胞白血病（PLL）的形态学、诊断及所考虑的治疗方案的综述。
T细胞PLL是一种罕见的血液疾病，在所有慢性白血病中占比极少。对与该疾病的细胞形态学和病理学相关的科学文献以及治疗方案的临床试验进行广泛综述，为本病例报告提供了背景资料。
腹部计算机断层扫描证实脾肿大，骨髓活检显示骨髓细胞增多，有大量小淋巴细胞浸润，符合该疾病表现，据此诊断为T细胞PLL。目前，T细胞PLL尚无最佳治疗方法，但阿仑单抗已显示出能成功延长生存期1至3年。
该病例在为患者及其家属做出化疗治疗决策时带来了一些伦理和实际挑战。该病例强调了医生和执业护士在支持或反对治疗时与患者、家属及其他护理人员建立合作关系的必要性。
