Clinic Review: Pernicious Anemia

Introduction

• Host: Dr. Sharon from Clinic Reviews
• Part of the Greater Klimek Review Organization by Mark Klimek
• NCLEX review offers lectures, book, and questions

Overview of Pernicious Anemia

• Not a complicated topic from a nursing perspective
• Anemia implies low hemoglobin

Pathophysiology of Pernicious Anemia

• Pernicious Anemia: Lack of intrinsic factor leading to inability to absorb Vitamin B12
• Vitamin B12 (extrinsic factor) is vital for RBC production
• Intrinsic factor: Produced in the body, necessary for B12 absorption

Risk Factors

• Autoimmune Disorders: The body attacks itself, leading to low intrinsic factor
• Chronic Gastritis/Gastric Surgery: Reduces intrinsic factor due to lowered gastric acid
• Long-term Use of Proton Pump Inhibitors: Affects gastric acid and intrinsic factor
• Family History: Genetic component to pernicious anemia

Symptoms

• Common Symptoms: Fatigue and weakness
• Neurologic Symptoms: Numbness, tingling, balance issues

Treatment

• Vitamin B12 Injections: Given parenterally (IM or sub-Q) due to absorption issues
• Monitoring: Regular checks of hemoglobin and hematocrit levels
• Lifelong Therapy: Necessary due to intrinsic factor deficiency

Nursing Interventions for IM B12 Injections

• Z-Track Method: Use if indicated
• Monitoring: Regular hemoglobin and hematocrit checks
• Injection Site: Assess for reactions or discomfort
• Patient Education: Need for lifelong therapy

Diagnostic Findings

• Macrocytosis: Large red blood cells
• Low Serum B12 Levels: Indicates extrinsic factor absorption issue
• Elevated Methylmalonic Acid: Newer diagnostic test
• Positive Schilling Test: Historical test using radioactive B12

Key Points

• Pernicious anemia results from inability to absorb Vitamin B12 due to lack of intrinsic factor
• Neurologic symptoms signal progression of the disease
• Lifelong B12 supplementation is required

Conclusion

• Pernicious anemia requires understanding of intrinsic and extrinsic factors
• Early symptoms are similar to other anemias: fatigue and weakness
• Neurologic symptoms, although serious, are not always present from the start

Thank you for being a part of the Clinic Review family. Have a great day!