Question

Mr. X, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B12 were below normal. Additional tests confirm pernicious anemia. Relate the pathophysiology of pernicious anemia to the manifestations listed above. (See Pernicious Anemia.) Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia. (See Pernicious Anemia—Pathophysiology, Etiology.) Discuss other tests that could be performed to diagnose this type of anemia. (See Pernicious Anemia—Diagnostic Tests.) Discuss the treatment available and the limitations. Classify pernicious anemia based on structural changes in erythrocytes, amount of hemoglobin and oxygen carrying capacity of RBC

Answer 1

Answer :

Pernicious anemia : this type of anemia occurs due to deficiency of vitamin B12.

It is also known as Magalobloblastic anemia.

Due to some of gastric abnormalities there is a loss of vitamin b 12 absorption.

Mainly vitamin b12 absorption will taken place in the small intestine, some of diseases to the small intestine leads to there is a deficiency of vitamin b12.

Those diseases are Crohns disease, ceiliac disease, any parasite or bacterial growth, immune system disorder such as graves disease ect.

Due to any of these disorders there is no proper absorption of vitamin b12.

Causes :

* the main cause is loss of stomach cells which prepare intrinsic factor, which will useful for absorption of vitamin

b 12.

* lack of folic acid intake.

* it may occurs due to loss of immune system.

Pathophysiology of pernicious anemia :

In the stomach in the presence of gastric acid and pepsin the animal protein releases the cobalamine, then this binds with the salivery R protein next it digested in the small intestine by some of pancreatic enzymes,

When there is a disorder in small intestine there is no absorption of vitamin b 12 taken place.

So it leads to pernicious anemia symptoms like nausea, diarrhea, soar, and swollen tongue, marked fatigue ect.

Diagnostic tests :

* raises serum bilurubin and LDH,

* raised serum methylmalonic acid and homocystine,  

* anti intrinsic factor antibodies,

* anti parietal cell antibodies,

* schilling test

* measurement of absorption of radiolabled cobalamine with intrinsic factor.

* measure urinary excretion of radioactivity.

Treatment :

* Administration of vitamin b12 that is cyanocobalamine 1000 units daily for one week and weekly for one month, and monthly for life long.

* iron and folic acid suplementation .

* blood transfusion in severe anemia.

* diet includes high protein, vitamin and mineral diet includes all green leafy vegetables, egg, meat, milk ect.

Classification of pernicious anemia :

* erythrocyte macro cystic pernicious anemia : in these deficiency in full matured red blood cells leads to there is a decreased oxygen carrying capacity of RBC leads to there is no sufficient breathing capacity leads to fatigue and some of parts tingling sensation may occurs.

* it is haematological pernicious anemia,

* gastric pernicious anemia,

* and immunological pernicious anemia.

Complications of pernicious anemia :

* neurological complications like loss of sensation and tingling ect.

* severe anemia leads to congestive heart failure, precipitating coronary insufficiency ect.

* gastric adino carcinoma of the client.