Pernicious Anemia Lecture Notes

Introduction

• Presented by Sarah, RN from register nurse rn.com.
• Part of the NCLEX review series on hematology.
• Covers: Pathophysiology, Diagnosis, Signs & Symptoms, Nursing Interventions.

What is Pernicious Anemia?

• Definition: A form of vitamin B12 deficiency anemia.
• Cause: An autoimmune condition where the body does not produce enough intrinsic factor.
• Role of Intrinsic Factor: Crucial for GI absorption of vitamin B12.

Pathophysiology

• Vitamin B12 Role: Essential for creating healthy red blood cells which carry oxygen.
• Anemia: Low red blood cells lead to decreased oxygen supply causing anemia.
• Intrinsic Factor: A protein helping in the absorption of vitamin B12 from food.
• Parietal Cells: Responsible for intrinsic factor production.
• Autoimmune Reaction: Antibodies attack parietal cells, reducing intrinsic factor and B12 absorption.

Causes

• Unknown but can be genetic or related to aging.
• Associated with endocrine disorders (e.g., Addison’s, thyroid problems, diabetes type 1).
• GI diseases or surgeries affecting parietal cells can lead to this condition.

Red Blood Cells in Pernicious Anemia

• Appearance: Large, oval-shaped, improperly dividing red blood cells.
• Bone Marrow Impact: Decreased production of healthy red blood cells.

Effects of Low B12 and Red Blood Cells

• Nervous System: Irreversible nerve damage leading to paresthesia, clumsiness, depression, muscle weakness.
• Cardiac System: Heart overworked due to low oxygen, risk of heart failure.
• GI System: Red beefy smooth tongue, disturbed taste, upset stomach, increased risk of stomach cancer.

Diagnosis

• Blood Tests: Complete blood count (CBC) to check red blood cells, hemoglobin, hematocrit.
• Peripheral Blood Smear: Examines size and shape of red blood cells.
• Vitamin B12 Levels: Direct measurement.
• Bone Marrow Aspiration/Biopsy: To inspect bone marrow directly.

Signs and Symptoms

• Mnemonic: PERNICIOUS
  • P: Pallor due to low oxygen.
  • E: Energy gone, fatigue.
  • R: Red smooth tongue from decreased blood flow.
  • N: Numbness and tingling (paresthesia) in extremities.
  • I: Intestinal issues like bloating, diarrhea, constipation.
  • C: Confusion.
  • I: Increased sadness (depression).
  • O: Loss of appetite and weight.
  • U: Unsteady gait.
  • S: Shortness of breath with activity due to low oxygen.

Nursing Interventions

• Goal: Replace vitamin B12 effectively.
• Vitamin B12 Injections: Administered intramuscularly.
• Blood Transfusion: If red blood cell count is critically low.
• Patient Education:
  • Safety regarding paresthesia and unsteady gait.
  • Diet advice on foods high in iron, vitamin C, and folic acid.
  • Oral hygiene due to tongue changes.

Conclusion

• Encouragement to take an online quiz at register nurse rn.com.
• Check other videos in the hematology series.
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