hey everyone it's Sarah register nurse rn.com and in this video I'm going to be doing an inlex review over pernicious anemia this video is part of an inlex review series over hematology so if you're studying that material be sure to check out those videos what I'm want to be doing in this videos I'm going to be covering the patho how it's diagnosed the signs and symptoms in the nursing interventions for pernicious anemia and as always over here on the side or in the description below you can access the quiz and the notes so let's get started first let's start out talking about what is pernicious anemia pricious anemia is a form of vitamin B12 deficiency anemia that is an autoimmune condition where the body does not produce enough intrinsic factor an intrinsic factor plays a huge role in how your GI system absorbs vitamin B12 so let's talk about the pathophysiology okay your body needs vitamin B12 to make healthy red blood cells and red blood cells play a big role in carrying oxygen through your body to your organs and your tissues so if you don't have enough red blood cells you're going to have anemia there's various forms of anemia previous video we talked about iron deficiency anemia so what happens you have low amounts of oxygen going through that blood and the body suffers because it doesn't like that so what happens is that your nervous system and your cardiac system are really um hurt by this and we'll talk a little bit more about that here in a second now in what is intrinsic factor intrinsic factor is a protein that helps your body absorb vitamin B12 so what happens is that intrinsic factor is a protein you take vitamin B12 in through food that's the only that's only how you can get it your body does not produce vitamin B12 so you eat some foods with vitamin B12 intrinsic factor protein gets that vitamin B12 and releases it into the gas gastric secretions to be absorbed and your paralal cells is what is responsible in your gut for producing this intrinsic factor and vitamin B12 is mainly absorbed by your ilum in your stomach so in pernicious anemia what happens it's an autoimmune condition so what happens is that the body starts to produce antibodies that attack those parial cells so they become attacked they can't do their job and release intrinsic factor so you don't absorb enough vitamin B12 and you get low levels and then you start making these really unhealthy red blood cells so um why does this happen the total cause is unknown however it can be genetic and run in families and the El elderly can have an issue with this I know in geriatric nursing you've probably learned about how the elderly have low vitamin B12 levels and this is due to um decrease acid production the older you get the less acid you produce hence the less intrinsic factor you'll produce also patients who struggle with endocrine disorders like Addison thyroid problems diabetes type one can experience this or patients who have gi diseases or had stomach surgery that destroy the prodal cells which in turn will um decrease your production of intrinsic factor now let's talk a little bit about how these red blood cells will appear so whenever you have low B12 what happens is that your red blood cells start to turn very large and they are oval shaped compared to this over here these are normal they're nice and round they're normal shaped and what happens is that your bone marrow produces your red blood cells along with many other things so your bone marrow releases it into the blood but in pricious anemia these red blood cells are very big they're not dividing properly so what happens is that your red your bone maror decreases production of it so you get pricious anemia now let's talk about how low B12 affects the body and how low red blood cells affect the body okay with low B12 major signs and symptoms which are going to see here in a second you're going to see nervous system changes with B12 it's really one of the big things that can differentiate it from the other types of anemia what happens is when you have low vitamin B12 levels you get irreversible damage to nerve cells so the patient may start experiencing paresthesia which is tingling or burning sensation in those extremities like the hands and the feet very uncomfortable also they can experience clumsiness because of that you have tingling and um Burning Sensations on your feet throws off your walking and you can become unsteady also patients can suffer with depression and muscle weakness another thing it reaks havoc on is your heart because remember your heart is responsible to of providing all your tissues and organs with oxygen and you have low amounts of oxygen in the body because you have messed up red blood cells and low amounts of them so your heart has to work hard harder to pump that blood throughout the system to get it some oxygen so your heart can only take so much so it gets weak it can enter into heart failure another thing that's affected is your GI system um whenever you have pernicious anemia the patient may have a very red beefy swollen smooth looking tongue and um it's from the decrease oxygen going to the tongue so that's going to mess up their taste their food's not going to taste as good may be painful also they can have an upset stomach from where the stomach lining is starting to thin and it increases the risk of stomach cancer people who have pernicious anemia now how is this diagnosed usually through blood tests there's various blood tests a physician can order as a nurse you need to be familiar with them um like a complete blood count also known as a CBC we'll look at the red blood cells hemoglobin hematocrit a peripheral blood smear this is where it will actually look at those red blood cells under a microscope and they'll have that appearance of looking very large and oval shaped rather than normal size and round also a doctor can check the vitamin B12 level or an intrinsic factor I say or they can um order which isn't a blood test they can order a bone marrow aspiration and biopsy go in there and the bone marrow aspirate that stuff out and look at that now let's look at the signs and S symptoms that you can see in pernicious anemia now these signs and symptoms tend to happen over time as the body is depleted of vitamin B12 because um a lot of vitamin B12 is stored in your liver and most in your liver and in your muscles so it'll happen gradually the patient may think it's something else they're just tired or something like that but to help you remember the signs and symptoms remember the word pernicious because we're talking about pernicious anemia so um the signs and symptoms have the little brown asteris by it that that is the big signs and symptoms that you're going to see in pricious anemia because remember vitamin B12 causes a lot of problems with the nervous system and the tongue okay so P they're going to be P palor because um they have low oxygen in the body so they may appear more white than normal e energy gone they're going to be very fatigued and tired and that is due to the low amounts of oxygen in the body R for red smooth tongue again like I said that's due to that decreased blood flow to the tongue it's going to cause it to look that beefy red and in for numbness SL tingling in the hands or feet and that's that paresia that's caused from that nerve damage of having the low B12 I for intestinal issues um because remember their um GI lining is starting to thin so they can get abdominal bloating they can have diarrhea or constipation and indigestion C for confusion I for increased sadness they'll struggle with depression and the O in the word loss loss of appetite which can lead to weight loss and this is due to you know the GI upset and the tongue changes food just doesn't taste like it normally does you for unsteady gate which we can trace back to the um numbness and tingling they can feel in the feet and then s for shortness of breath with activity they can normally tolerate and that's because of the low oxygen levels because of the decreased red blood cells now what are the nursing interventions what are you going to do for this patient as the nurse okay the goal is to replace the patient's vitamin B12 now the patient cannot you can tell them to eat all the vitamin B12 they want all day tell them about rich foods but it's just not going to help because why they don't have that intrinsic factor to take that B12 and release it in the gastric secretion so the ilium can and absorb it so we're not going to give them vitamin B12 in a pill through the mouth because it's not going to work it's going to go in the GI system is not going to do its job so they needed another route so the doctor would probably order um you to give vitamin B12 injections which is normally given I intramuscularly and first depending on how severe it is um they'll start out with weekly injections of vitamin B12 and then progress to month ly and if they have this really bad they may have to do this for life so they're absorbing vitamin B12 also if they're really really low in red blood cells they may need a blood transfusion so you'll be responsible as a nurse for doing that and you'll want to educate the patient on safety due to that paresthesia that they have in their hands and on their um feet and being unsteady confused at times so they want to make sure they're watching how they walk and you want to educate them on eating foods high in iron vitamin C and folic acid because even though um you know eating foods rich in vitamin B12 will be great but they can't really absorb it but other types of anemia like iron deficiency anemia they don't eat enough Foods in iron and vitamin C because iron and vitamin C go together the vitamin C helps you absorb iron you can um also get iron deficiency anemia because it plays a role iron plays a role in making red blood cells and folic acid does well so you want to educate them about that and how to do good oral hygiene because the tongue is has changes okay so that is about pricious anemia now go to my website register nurse rn.com and take the free review quiz that will test you on this knowledge that you just learned and be sure to check out the other videos in this series and don't forget to subscribe to this YouTube channel