Cobalamin deficiency Anemia Flashcards
What is the most common cause of Cobalamin deficiency?
Pernicious anemia
What is the cause or like actual diagnosis of Cobalamin Deficiency ( Pernicious anemia )?
Absence of intrinsic factor
(factors that are needed to make RBC)
Pernicious anemia is a disease of what?
Insidious onset
When do we usually see cobalamin deficiency happening in life?
Middle age or later ( usually after 40 )
Pernicious anemia mainly occurs often in which type of people?
Northeran European ( Scandinavians )
And African American
What is the Cobalamin (B12) Deficiency etiology? (4)
The steps and how it works
Normally the parietal cells of the gastric mucosa secrete IF
IF is required for cobalamin absorption
We absorb cobalamin in the distal ileum
Without IF, we don’t absorb that Cobalamin
In pernicious anemia etiology, the gastric mucosa does not secrete IF because of what? (2)
Gastric mucosal atrophy or autoimmune destroy of parietal cells
How does the auto immune process of antibodies work for cobalamin deficiency?
Because antibodies are directed against the gastric partial cells and IF
Because of secreting hydrophilic acid which when having this deficiency, you have a decrease in HCI in stomach
Is an acid environment needed in the stomach for IF secretion?
Yes
What are some risk factors that increase the risk for getting cobalamin deficiency? (8)
Metformen- B12 deficiency
GI surgery
Chronic disease GI
Excess alcohol
Hot tea ingestion
Long term users of H2- Histamine receptor blockers and proton pump inhibitors
Strict Vegetarians
Family history
Metformen is a medication given to diabetic 2 patients and usually ???
How does it do this?
They have a difficult time absorbing B12 ( cobalamin )
Speeds it up so there isn’t enough time for that cobalamin to be absorbed
Cobalamin Deficiency
clinical Manifestations
Is it slow or fast anemia due to hypoxia?
Slow
What are the clinical manifestations?
Gastrointestinal (5)
Neuromuscular (6)
Sore tongue
Anorexia
Nausea
Vomiting
Abdominal pain
Weakness
Paresthesia( feet & hands )
Decrease vibratory or position senses
Ataxia ( impaired balanced)
Muscle weakness
Impaired thought process
Because Cobalamin deficiency anemia is insidious onset, it may take ??
Several months or years for manifestations to develop
What’s the big manifestations for GI manifestations and Neuro? (2)
Sore red beefy shiny tongue
Paresthesia of feet & hands
Diagnostic studies
Due to Cobalamin Macrocytic RBC having an abnormal shape and fragile cell membrane, what does it do to us?
It inhibits the ability for the cell to be able to grab on to hemoglobin and allow for the carry of oxygen throughout the body
What are the 4 diagnostic studies ?
Macrocytic RBC have abnormal shape & fragile cell membranes
Serum cobalamin levels are decreased
Normal serum folate levels
Low cobalamin
= megaloblastic anemia due to b12
Upper GI endoscopy with biopsy of gastric muscles related to GI cancer
What is the test specific for pernicious anemia?
Serum test for anti IF antibodies
Patients have a higher risk if ___?
That’s why we do ____ (2)in order to help diagnosis
Gastric cancer
Gi endoscopy & biopsy of gastric mucosa
Can you give PO ( oral treatment ) to patients with Cobalamin Deficiency? Why?
No
Because the reason why they are having this problem is because they can not absorb cobalamin through daily intake cause of their gastric issue
So taking oral, they are not gonna be able to absorb it
What is the treatment for cobalamin Deficiency? (2)
Parenteral or Intravascular administration
Patients will die after how many years without treatment?
1-3 years
Can cobalamin deficient be reversed with ongoing treatment ?
Can it be said for long standing neuromuscular complications?
Yes
No
(Paresthesia)
As nurses we want to do what for these patients? (5)
Early detections and treatment
Ensure safety
Decrease sensation to heat & pain
Protect from falling, burns, trauma
Physical therapy may be needed
