- QUESTION
Deb Smith, age fifty-six, came to her nurse practitioner (NP) with fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high; and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.
Answer the following questions regarding Deb’s anemia and provide the pathophysiology associated with the body’s response to this disease process.
Why should Deb's NP ask her about paresthesia and ataxia?
Why did her NP prescribe vitamin B12 by intramuscular injection rather than orally?
What causes pernicious anemia?
What are the technical terms that describe an anemia with high MCV and normal MCH?
| Subject | Nursing | Pages | 3 | Style | APA |
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Answer
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Pernicious Anemia
Paresthesia and Ataxia
Symptoms of pernicious anemia are insidious and vague with instances of classic tiad of weakness, paresthesias, and sore tongue but are not the chief symptom complex. Neurologic complaints are usually the first symptoms of CbI deficiency in most cases especially paresthesias and ataxia. Paresthesias and ataxia as such becomes two chief symptoms of neurological symptoms of pernicious anemia. Untreated patients are likely to develop limb weakness and ataxia. The combination of sensory ataxic gait and paresthesias is caused by dysfunction of the dorsal columns and has signs and symptoms similar to those of pernicious anemia (Hirokawa, 2014).
Vitamin B12 by Intramuscular Injection Rather Than Orally
Because the underlying deficit in pernicious anemia is malabsorption of the vitamin B12, then effective treatment would involve intramuscular vitamin B12 as opposed to the oral vitamin therapy (Bizzaro & Antico, 2014).
Causes Pernicious Anemia
Pernicious anemia is caused by lack of intrinsic factor or other causes such as surgery, infections, diet, and medicines. The intrinsic factor is a protein that is made in the stomach that helps the body absorb vitamin B12. Autoimmune responses occur in some people and cause a lack of intrinsic factor. If the immune system makes antibodies that mistakenly attack and damage the body cells or tissues, then an autoimmune response occurs. Since the intrinsic factor helps the body absorb vitamin B12, in pernicious anemia where the body makes antibodies that attack and destroy the parietal cells makes the stomach stop making the intrinsic factor. Lack of the intrinsic factor causes inability to move vitamin B12 through the small intestine for absorption and causes vitamin B12 deficiency. Pernicious anemia can also be caused by lack of vitamin B12 and malabsorption in the small intestine (Hirokawa, 2014).
technical terms that describe an anemia with high MCV and normal MCH
- MCV less than lower limit of normal: microcytic anemia
- MCV within normal range: normocytic anemia
- MCV greater than upper limit of normal: macrocytic anemia
- MCH less than lower limit of normal: hypochromic anemia
- MCH within normal range: normochromic anemia
- MCH greater than upper limit of normal: hyperchromic anemia (Bizzaro & Antico, 2014)
References
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Bizzaro, N., & Antico, A. (2014). Diagnosis and classification of pernicious anemia. Autoimmunity Reviews, 13(4-5), 565-568. doi:10.1016/j.autrev.2014.01.042 Hirokawa, M. (2014). [Recent progress of diagnosis and treatment for immune-mediated hematological diseases. Topics: III. Diagnosis and treatment: 3. Pernicious anemia]. Nihon Naika Gakkai Zasshi. The Journal Of The Japanese Society Of Internal Medicine, 103(7), 1609-1612.
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