Pernicious Anemia

Question 1

What is pernicious anemia ?

Answer 1

Pernicious anemia is a form of vitamin B12 anemia that is an autoimmune condition where the body does not produce intrinsic factor, which plays a role in absorbing vitamin B12

Question 2

Why does your body need vitamin B12?

Answer 2

The body needs vitamin b 12 to make healthy red blood cells

Question 3

A protein called __________ plays a role in the body’s ability to absorb vitamin b 12.

Answer 3

intrinsic factor

Question 4

You take vitamin B12 in through food. The body does not produce vitamin B12. TRUE OR FALSE

Answer 4

TRUE

Question 5

Vitamin b12 is not produced by the body but is taken in through food with the help of a protein called _____________

Answer 5

intrinsic factor

Question 6

In pernicious anemia, there isn’t enough ____________ to help with absorption of__________ in the stomach (total cause unknown but can be due to stomach surgery or GI disease etc).

Answer 6

INTRINSIC FACTOR; vitamin B12

Question 7

How does intrinsic factor help the body absorb vitamin B12?

Answer 7

It attaches to the vitamin B 12 found in the food you consume and releases it into the stomach acid. Then the vitamin b 12 is absorbed by the ileum. The parietal cells in the stomach produce intrinsic factor and can become damaged from an autoimmune response in the system. Antibodies attack the parietal cells which damages them to the point where they cannot produce intrinsic factor. GI disease and stomach surgery can destroy parietal cells which decrease the production of intrinsic factor.

Question 8

What happens to the red blood cells in the pernicious anemia?

Answer 8

If vitamin b 12 levels are too low this can lead the body to produce unhealthy red blood cells. Instead of the RBCs being normal sized and round, they become large and are shaped like an oval (also called macrocytic anemia…learn about microcytic anemia in iron-deficiency anemia).

This in turn causes the bone marrow (which in responsible for producing RBCs) to produce less of them and the RBCs have a hard time leaving the bone marrow because they are too big and don’t divide properly.

Red blood cells play a HUGE role in carrying oxygen throughout the body to organs and tissues, but if there aren’t enough RBCs the body doesn’t receive enough oxygen. In pernicious anemia, there are low amounts of RBCs and organ systems start to suffer, especially the heart and neuro system.

Question 9

How low vitamin b 12 and low RBCs affect the body?

Answer 9

Nervous System (majorly affected in pernicious anemia): low vitamin b 12 causes irreversible damage to nerve cells so the patient can experience paresthesia.

Heart: it has to work harder to pump blood to get oxygen to the organs and tissue which can eventually lead to heart failure.

Intestinal: tongue becomes red, beefy, swollen and smooth from decreased oxygen and the stomach lining begins to thin which can cause an upset stomach and increase risk of stomach cancer.

Question 10

Risk Factors for Pernicious Anemia

Answer 10

Aging: older adults can experience this due to decreased production of gastric acid and intrinsic factor.
Genetic
Autoimmune disease of the endocrine system: Addison’s, Diabetes Type 1 etc

Question 11

How is Pernicious Anemia Diagnosed?

Answer 11

CBC: to measure RBCs, hgb, hct
Blood smear to look at RBC (will appear large and oval)
Vitamin b12 level
Intrinsic factor antibody assay
Bone marrow aspiration and biopsy

Question 12

Signs and Symptoms of Pernicious Anemia

Signs and symptoms may take a while to be noticed by the patient.

*=most common in pernicious anemia

Remember the mnemonic: Pernicious

Answer 12

Pale

Energy gone (very fatigued)*

Red, smooth tongue (due to decreased blood flow to the tongue)

Numbness or tingling in hands and feet*

Intestinal issues (abdominal bloating, diarrhea/constipation, indigestion)

Confusion

Increased sadness (depression)

lOss of appetite (taste changes and weight loss)

Unsteady gait (clumsy)

Shortness of breath with activity

Question 13

vitamin B12 deficiency causes a lot of problems especially with the _________ system and the ___________-

Answer 13

neuro; tongue

Question 14

Nursing Interventions for Pernicious Anemia: What is the Goal ?

Answer 14

Goal replace vitamin b 12 (patient can’t receive vitamin B12 from food…so they will need it a different route)

Question 15

Nursing interventions for Pernicious Anemia

Answer 15

Administer vitamin b 12 injections (intramuscular….not orally because they aren’t absorbing it in the GI system) as ordered by doctor.
Regime is usually weekly at first and then monthly for maintenance (for lifetime)….if severe anemia will need blood transfusion

Educated on safety: due to risk of injuries from unsteady gait…more clumsy from the paresthesia

Educate about importance of eating enough foods with iron, vitamin C, and folic acid because these nutrients play a role in red blood cell production as well.

Maintain good oral hygiene due to changes to tongue.

Question 16

injections of Vitamin B12 will occur through which route

Answer 16

Intramuscular

Question 17

what shape and appearance will the RBCs in pernicious anemia have ?

Answer 17

Instead of the RBCs being normal sized and round, they become large and are shaped like an oval (also called macrocytic anemia…learn about microcytic anemia in iron-deficiency anemia).

Question 18

Cyanocobalamin is essential for ____________ synthesis. It can take up to ____________ years for the vitamin B12 stores to be depleted and for symptoms of pernicious anemia to appear. Symptoms can include weakness, fatigue, anorexia, loss of taste, and diarrhea. To correct deficiencies, a crystalline form of vitamin ______, cyanocobalamin, can be given intramuscularly

Answer 18

DNA; 3; B12