Cobalamin deficiency Anemia

Question 1

What is the most common cause of Cobalamin deficiency?

Answer 1

Pernicious anemia

Question 2

What is the cause or like actual diagnosis of Cobalamin Deficiency ( Pernicious anemia )?

Answer 2

Absence of intrinsic factor
(factors that are needed to make RBC)

Question 3

Pernicious anemia is a disease of what?

Answer 3

Insidious onset

Question 4

When do we usually see cobalamin deficiency happening in life?

Answer 4

Middle age or later ( usually after 40 )

Question 5

Pernicious anemia mainly occurs often in which type of people?

Answer 5

Northeran European ( Scandinavians )
And African American

Question 6

What is the Cobalamin (B12) Deficiency etiology? (4)
The steps and how it works

Answer 6

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

Question 7

In pernicious anemia etiology, the gastric mucosa does not secrete IF because of what? (2)

Answer 7

Gastric mucosal atrophy or autoimmune destroy of parietal cells

Question 8

How does the auto immune process of antibodies work for cobalamin deficiency?

Answer 8

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

Question 9

Is an acid environment needed in the stomach for IF secretion?

Answer 9

Yes

Question 10

What are some risk factors that increase the risk for getting cobalamin deficiency? (8)

Answer 10

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

Question 11

Metformen is a medication given to diabetic 2 patients and usually ???

How does it do this?

Answer 11

They have a difficult time absorbing B12 ( cobalamin )

Speeds it up so there isn’t enough time for that cobalamin to be absorbed

Question 12

Cobalamin Deficiency
clinical Manifestations
Is it slow or fast anemia due to hypoxia?

Answer 12

Slow

Question 13

What are the clinical manifestations?
Gastrointestinal (5)
Neuromuscular (6)

Answer 13

Sore tongue
Anorexia
Nausea
Vomiting
Abdominal pain

Weakness
Paresthesia( feet & hands )
Decrease vibratory or position senses
Ataxia ( impaired balanced)
Muscle weakness
Impaired thought process

Question 14

Because Cobalamin deficiency anemia is insidious onset, it may take ??

Answer 14

Several months or years for manifestations to develop

Question 15

What’s the big manifestations for GI manifestations and Neuro? (2)

Answer 15

Sore red beefy shiny tongue

Paresthesia of feet & hands

Question 16

Diagnostic studies
Due to Cobalamin Macrocytic RBC having an abnormal shape and fragile cell membrane, what does it do to us?

Answer 16

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

Question 17

What are the 4 diagnostic studies ?

Answer 17

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

Question 18

What is the test specific for pernicious anemia?

Answer 18

Serum test for anti IF antibodies

Question 19

Patients have a higher risk if ___?
That’s why we do ____ (2)in order to help diagnosis

Answer 19

Gastric cancer
Gi endoscopy & biopsy of gastric mucosa

Question 20

Can you give PO ( oral treatment ) to patients with Cobalamin Deficiency? Why?

Answer 20

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

Question 21

What is the treatment for cobalamin Deficiency? (2)

Answer 21

Parenteral or Intravascular administration

Question 22

Patients will die after how many years without treatment?

Answer 22

1-3 years

Question 23

Can cobalamin deficient be reversed with ongoing treatment ?

Can it be said for long standing neuromuscular complications?

Answer 23

Yes

No
(Paresthesia)

Question 24

As nurses we want to do what for these patients? (5)

Answer 24

Early detections and treatment
Ensure safety
Decrease sensation to heat & pain
Protect from falling, burns, trauma
Physical therapy may be needed

Question 25

Why would patients need physical therapy?

Answer 25

To help aid with the numbness & tingling

Question 26

What foods to give to patient with cobalamin ( B12)?

Answer 26

Meat
Eggs
Enriched grain products
Milk
Dairy foods
Fish ( especially salmon )