Pernicious Anemia

Pernicious Anemia Treatment

- early parenteral vitamin b12 replacement - iron and folic acid replacement to prevent iron deficiency anemia due to rapid cell regeneration, increasing the pt iron and folate levels - after initial response, decreasing vitamin b12 dosage to monthly self admin maintenance dose - bed rest for extreme fatigue until hgb level rises - blood transfusions for dangerously low hgb levels - digoxin, diuretic and low sodium diet if pt is in heart failure.

Pernicious Anemia Complication

- gastric polyps - hypokalemia - permanent cns symptoms - stomach cancer

Pernicious Anemia Causes

- gi bypass, partial gastrectomy - genetic predisposition - immunologically related diseased - chronic alcoholism - long term use of proton pump inhibitors blocks the release of intrinsic factor - older age

Pernicious Anemia Diagnostic Test Finding

- hgb is increased - rbc count is decreased - cv is > 10 ul - serum vitamin b12 level is < 0.1 ug/ml - bone marrow aspirations shows erythroid hyperplasia with increased numbers of megaloblasts but few normally developing rbc - gastric analysis shows absence of free hcl acid after histamine or penagastrin injection - schilling test for excretion of radiolabeled vitamin b12 is the definitive test for pernicious anemia - serologic findings include intrinsic factor antibodies and antiparietal cell antibodies

Underlying Pathophysiology

- inherited autoimmune response may cause gastric mucosal atrophy and resultant decreased production of hydrochloric acid and intrinsic factor, a substance normally secreted by parietal cells of gastric mucosa - intrinsic factor deficiency inhibits vitamin b12 absorption, which inhibits cell growth, especially rbcs leading to a production of small deformed cells with poor o2 carrying capacity. - neurological damage occurs because vitamin b12 deficiency impairs myelin formation

Pernicious Anemia

- most common type of megaloblastic anemia - characterized by an inability to absorb viramin B12, it may be associated with loss of intrinsic factor (gi resection) or may be an autoimmune problem

Pernicious Anemia Pathophysiological Changes

- weakness, pallor due to tissue hypoxia - smooth, beefy red tounge due to atrophy of the papillae - numbness and tingling in the extremities as a result of interference with impulse transmission from demyelination. - faintly jaundiced sclera and skin due to hemolysis induced hyperbilirubineremia - progressive neurologic symptoms due to interference of nerve impulse transmission form demyelination, including lack of coordination, ataxia, positive Babinski signs, light headedness, altered vision and taste, tinnitus, loss of bowel and bladder control, irritability, poor memory, has, depression, and delirium - low hgb - palpitations, wide pulse pressure, dyspnea, orthopnea, tachycardia, can progress to heart failure.

Pernicious Anemia Nursing Considerations

1. If the patient has severe anemia, plan activities, rest periods, and necessary diagnostic tests to conserve energy. 2. Monitor pulse rate often; tachycardia means the patient's activities are too strenuous. 3. To ensure accurate Shilling test results, make sure all urine over a 24-hour period is collected and that specimens are uncontaminated 4. Provide a well-balanced diet, including foods high in vitamin B12. 5. Stress that vitamin B12 replacement isn't a permanent cure and that these injections must be continued for life, even after symptoms subside. 6. To prevent pernicious anemia, emphasize the importance of vitamin B12 supplements for patients who have had extensive gastric resections or who follow strict vegetarian diets. 7. Monitor for gastric cancer (increased potential with pernicious anemia).