PERNICIOUS ANEMIA

Prepared by: Michelle Anne

PERNICIOUS ANEMIA

Historical View:

First described in 1849 by Thomas Addison Was termed fatal and called Pernicious due to similar symptoms found in Leukemia and Cancer. Dr. George Whipple produced the first cure for PA which is raw liver. In 1948 Vitamin B12 was introduced as the main source of cure of PA patients. Today, the term pernicious is no longer appropriate, but it is retained for historical reasons

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A.K.A: 1. Macrocytic Achylic Anemia 2. Congenital / Juvenile Pernicious Anemia

A rare autosomal recessive indicated as early onset and presents before age 2 with significantly decreased low levels of IF but normal gastric secretions.

3.

Megaloblastic Anemia
characterized by the presence of enlarged cells (megaloblasts) due to the impaired cell division

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Definition:
A chronic illness caused by impaired absorption of vitamin B-12 due to a lack of intrinsic factor (IF) in the stomach. An adult onset but usually diagnosed around the age of 60

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Intrinsic Factor:

Vitamin B12:

A glycoprotein secreted by the parietal cells in the stomach lining Facilitates absorption of vitamin B12 in the small intestine

Necessary in the formation of red blood cells Maintenance of the central nervous system Is important for metabolism Can be found in: Eggs, meat, shellfish, milk, orange, broccoli, asparagus, green leafy vegetables, peas, peanuts, beans chickpeas

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Risk factors:
Family history History of autoimmune disorders such as:
Vitiligo

Addisons Disease Hypothyroidism

Scandinavian descent Elderly Age 60 and above Alcoholics

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Causes:

Weakened stomach lining (atrophic gastritis)

The body's immune system attacking the cells that make intrinsic factor or intrinsic factor itself

Long term use of certain drugs that can reduce the acid in the stomach lining such as metformin, and biguanides.

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Lack of Vitamin B12 in the diet which is common among vegetarians. From certain intestinal disorders that interfere with the absorption of vitamin B12, such as Crohn's disease and intestinal infections. Surgery such as Gastrectomy or Gastric Bypass for weight loss

PATHOPHYSIOLOGY
Predisposing factors: Age
Race Family History Autoimmune Disorders

Precipitating factors: Diet

Surgery Drugs affecting the absorption of vitamin B12

Hypoxia Pallor Fatigue Pale nail bed Loss of appetite

Weakened gastric lining loss of parietal cells

Lack of intrinsic factor in the stomach

Disorientation Irritability Personality changes Dementia

Decrease in Vitamin B12

Dizziness

Headache Diarrhea Poor concentration Shortness of breath Weakness Altered taste perception

Decrease in production of Red Blood Cells

Abnormal red blood cell (Macrocytic)

Beefy red tongue Depression Loss of balance Memory loss short term Numbness or tingling sensation in arms or legs

Pernicious Anemia

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Symptoms:

Dizziness Pallor Fatigue, lack of energy

Diarrhea or constipation Loss of appetite Problems concentrating Shortness of breath Beefy red tongue - pathognomonic

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Numbness and tingling of hands and feet Personality changes Confusion Short term memory loss Dementia Depression Loss of balance

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Diagnostic tests:

Complete blood count (CBC) Reticulocyte count Serum vitamin B12 level Bone marrow examination Schilling test

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Treatment:

IM B-12 at 1000 mcg daily for one week, then 1000 mcg weekly for one month, then 1000 mcg every month for one year indefinitely. Some doctors recommend that elderly patients with gastric atrophy take vitamin B12 supplements by mouth in addition to monthly injections. There is also a preparation of vitamin B12 that may be given through the nose.

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Nursing interventions:
1.

Plan activities, rest periods, and necessary diagnosis test to conserve the patient energy Monitor pulse rate often. For adequate schilling test results, all urine over 24 hrs period should be collected and the specimen not contaminated with feces Warn the patient to guard against infections and to report signs of infection promptly

2.

3.

4.

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5.

Provide well balanced diet, including foods high in vitamin B12 Avoid giving irritating food since the patients mouth and tongue are sore and painful

6.

7.

Warn the patient with sensory deficit not to use a heating pad since it may cause burn

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Prognosis:

Pernicious anemia is usually easy to treat with vitamin B12 pills or shots People with pernicious anemia who get proper lifelong treatment can have a normal lifespan.

Complications:

People with pernicious anemia may have gastric polyps, and they are at increased risk for gastric cancer and gastric carcinoid tumors. Brain and nervous system (neurological) problems may continue if treatment is delayed.

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Conclusion:
Pernicious anemia is common among the aging. The disease is a result of impaired absorption of Vitamin B12 due to a deficiency of Intrinsic Factor. The cause is unknown; it affects multiple systems of the human body but if recognized and treated early, all effects are completely reversible. Although the treatment is lifelong, it is relatively simple and convenient to the patient.

Thank You!!