RUNNING HEAD: LEUKEMIA
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Coach Pagano’s Leukemia
Frances Fremin Mascagni, RN
Southeastern Louisiana University, Graduate School of Nursing
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LEUKEMIA
In 2012 Chuck Pagano, head coach for the Indianapolis Colts, was diagnosed with APL,
short for Acute Promyelocytic Leukemia (ESPN, 2012). There are different kinds of leukemia,
but generally speaking they are all abnormal proliferations of the leukocytes, known also as
white blood cells (WBCs). WBCs are either granulocytes (neutrophils, basophil or eosinopil) or
agranulocytes (lymphocytes and monocytes). The exact etiologies of leukemias are not known,
but typically attributed to “disruption in the activity of genes that normally regulate blood cell
development.” Acute Myeloid Leukemia (AML) is associated with genetic problems that inhibit
terminal myeloid differentiation (Grossman & Porth, 2014, p701). APL, which is a form of
AML is consistent with a t(15;17) chromosomal translocation (Krug, Buchner, Berdel & Muller,
2011, p.868).
Leukemia is classified as acute or chronic, and either proliferation of the lymphoid or
myeloid cells predominate (Porth, 2015, p.645). Acute forms have sudden onset of symptoms,
including fatigue, fever, night sweats, weight loss, bleeding, bone pain, hepatomegaly,
splenomegaly, and lymphadenopathies. Chronic forms are typically only seen in elderly, and
patients may initially be asymptomatic, or have insidious presentations similar to associated with
acute forms (Porth, 2014, p.704). Lymphoid leukemia involves immature lymphocytes and the
acute form is typically more common in children. In contrast, myelogenous leukemia originates
from pluripotent myeloid stem cells of bone marrow and “interferes with the maturation of all
blood cells including the granulocytes, erythrocytes and thrombocytes.” AML is more frequent
in adults and involves pluripotent stem cells, which are precursors to unipotential colonyforming units that further differentiate into individual blood cell types. (Grossman & Porth,
2014, p.701)
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LEUKEMIA
Hospitalization was required for several weeks following Pagno’s initial induction phase
of treatment for APL. This length of stay is typical due to chemotherapy use. It aims to illicit a
bone marrow response that destroys the leukemic cells in hopes of normal bone marrow
recovery. Serious complications, such as tumor lysis syndrome (TLS) and pancytopenia, can
occur during this time (Grossman & Porth, 2014, p701).
TLS can result in a multitude of fatal
metabolic disorders or renal failure. Pancytopenia, a triad of blood dyscrasias including anemia,
neutropenia, and thrombocytopenia, can increase fatigue, possibility for infections or risk of
bleeding (Grossman & Porth, 2014, p.193). Risk for infection is especially high as neutrophils
are the blood’s “first line of defense,” and infection treatment and prevention measures such as
antibiotics and neutropenic precautions need to be strictly followed (Grossman & Porth, 2014, p.
695). It is standard for patients like Pagano to remain in the hospital for several weeks to obtain
supportive management such as fluids or transfusions due to these common complications, but
luckily his form of leukemia has a very good prognosis with prompt treatment (Krug, Buchner,
Berdel & Muller, 2011, p.868).
References
ESPN.com (2012, October 1). Chuck Pagano battling leukemia. Retrieved February 2, 2016,
from http://espn.go.com/nfl/story/_/id/8447831/indianapolis-colts-coach-chuck-paganoleukemia
Grossman, S. & Porth, C.M. (2014). Porth’s pathophysiology: Concepts of altered health states
(9th ed, p.1258). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins.
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LEUKEMIA
Kelley, C. (2012, October1) Pagano being treated for form of leukemia. Colts.com. Retrieved
February 2, 2016, from http://www.colts.com/news/article-1/PAGANO-BEINGTREATED-FOR-FORM-OF-LEUKEMIA/b3341127-1a3b-4b52-9b1c-95343f39a093
Krug, U., Buchner, T., Berdel, W.E. & Muller-Tidlow, C. (2011). The treatment of elderly
patients with acute myeloid leukemia. Deutsches Aerrzteblatt International, 108(51/52).
863-870 8p. Doi:10.3238/arztebl.2011.0863