Introduction
Pernicious anemia refers to a health condition that is associated with a deficiency in vitamin B12 due to its poor absorption in the intestines whereby this results to a reduction in the RBCs (red blood cells). Typically, the condition occurs as a result of inadequate production of IF (Intrinsic Factor) in the stomach whereby this leads to poor absorption of vitamin B12 (Bizzaro & Antico, 2014). Among the main symptoms associated with the disease include; fatigue, diarrhea, breathing difficulties, pale skin as well as tingling and numbness in the feet and hands.
In reference to the case study, it is important for Deb’s NP to inquire from her about ataxia as well as paresthesia. As such, Deb’s NP should ask inquire from her about paresthesia so as to determine the severity and progression of the disease in relation to neurological impairment since paresthesia is among the key neurologic symptoms. For instance, paresthesia is one of the most common manifestation for peripheral neuropathy and mainly affects the lower extremities. On the other hand, the NP should ask her about ataxia in order to evaluate the progression of the disease in relation to nerve damage especially the brain nerves since ataxia is among the key symptoms associated with damage of the brain nerves. Moreover, this helps to evaluate the progression of the disease since lack of treatment usually results to ataxia. According to Stabler (2013), the two components (ataxia and paresthesia) helps in the evaluation of nutritional status as well as neurological dysfunction.
Deb’s NP prescribed vitamin B12 by intramuscular injection instead of oral administration since intramuscular injection promotes faster, efficient and good absorption of the vitamin thereby resulting to better outcomes. According to Sanz-Cuesta et al. (2012), intramuscular injection is the most efficient administration route for vitamin B12 since it is associated with efficient absorption of the vitamin into the blood stream as compared to oral administration. Moreover, intramuscular injections are the most appropriate administration route especially among individuals with gastrointestinal problems. Additionally, intramuscular injections provides certainty to the nurse in regard to administration as compared to oral administration that mainly depends on the patient’s compliance.
Pernicious anemia is mainly caused by a deficiency in vitamin B12 that is usually associated with poor absorption of the vitamin in the intestines due to inadequate production of IF, a gastric protein that facilitates absorption of the vitamin (Bizzaro & Antico, 2014). Moreover, the disease may be caused by poor consumption of foods that contain vitamin B12 such as fish and milk. The disease is also caused by various stomach conditions such as gastrectomy that affect vitamin B12 absorption.
There are various technical terms are used to describe an anemia characterized by normal MCH and high MCV. Among the key technical terms used include; macrocytic normochromic anemia and vitamin B12 deficiency.
Pathophysiology
Essentially, pernicious anemia occurs as a result of inadequate secretion of IF by the parietal cells whereby this leads to insufficient absorption of vitamin B12. Consequently, vitamin B12 deficiency causes a reduction in the RBCs since the production and maturity of the RBCs largely depends on vitamin B12. Thus, individuals suffering from the disease usually experience a dysfunction of the red blood cells whereby this leads to a decline in tissue oxygenation (Stabler, 2013). In addition, the condition may develop due to cobalamin deficiency that occurs due to its inadequate absorption in the intestines. Typically, the enzymes usually require vitamin B12 in order to convert homocysteine to methionine as well as methylmalonyl CoA to succinyl CoA. As such, lack of vitamin B12 or insufficiency of the vitamin results to an accumulation of the affects the aforementioned enzyme reactions whereby this results to methylmalonyl CoA accumulation that leads to neurological dysfunction.
References
Bizzaro, N., & Antico, A. (2014). Diagnosis and classification of pernicious anemia. Autoimmunity reviews, 13(4), 565-568.
Sanz-Cuesta, T., González-Escobar, P., Riesgo-Fuertes, R., Garrido-Elustondo, S., del Cura-González, I., Martín-Fernández, J., & Martín-de la Sierra, M. Á. (2012). Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12). BMC public health, 12(1), 394.
Stabler, S. P. (2013). Vitamin B12 deficiency. New England Journal of Medicine, 368(2), 149-160.
