Deb is a 56-year-old woman who suffers from pernicious anemia and who has asked her nurse practitioner to help. In spite of having anemia, her laboratory results demonstrate that the mean corpuscular volume (MCV) is rather high, and the mean corpuscular hemoglobin (MCH) is normal in contrast to low levels of hemoglobin and hematocrit. It is important to discuss what pathophysiological processes are caused by her disease.
The pernicious anemia is caused by the lack of vitamin B12. This deficiency usually leads to changes in the neurological processes. The nerve fibers in spinal cord lateral columns degenerate, and this process causes abnormal symptoms such as the loss of reflexes or, on the contrary, increased and intense reflexes (Huether & McCance, 2016). Possible paresthesia and ataxia are also caused by these processes, as well as the associated weakness in muscles (Yang & Cook, 2012). The nurse practitioner should ask Deb about these conditions because they clearly indicate the presence of the pernicious anemia, and the discussion of these symptoms can provide the nurse with information regarding the disease development.
In order to overcome symptoms and treat pernicious anemia, it is important to take vitamin B12 regularly. However, with the focus on this type of anemia, vitamin B12 that is prescribed to be taken orally will not be effective. The problem is in the fact that the intrinsic factor necessary for the absorption of vitamin B12 is lacking in the gastrointestinal tract of persons suffering from pernicious anemia (Yang & Cook, 2012). If a person takes vitamin B12 orally, it has no effects because it is not absorbed as those vitamins are usually absorbed from the food (McCance & Huether, 2015). Therefore, the intramuscular injection of vitamin B12 can guarantee high results because of leading to direct substance absorption in muscles.
The discussion of the impossibility of taking vitamin B12 orally is important to explain the causes of pernicious anemia. The primary cause is the intrinsic factor deficiency in the stomach (McCance & Huether, 2015). The absence of this substance prevents the absorption of vitamin B12. A person begins to suffer from vitamin B12 deficiency. As a result, pernicious anemia develops, and it affects the progress of the neurologic symptoms, problems with the heart, and gastric dysfunction (Yang & Cook, 2012). These symptoms are the consequences of the vitamin B12 deficiency and associated production of affected red blood cells that cannot transport oxygen to the tissues. The abnormalities in the work of the mentioned systems are the results of the inability to receive enough vitamin B12 and oxygen. The lack of the intrinsic factor can be of a genetic origin, or it can be the autoimmune reaction of the body to certain factors that leads to vitamin B12 malabsorption.
Deb’s laboratory results are interesting to be discussed in terms of observing the high MCV and the normal MCH. Anemia can be classified according to different factors. When the mean corpuscular volume is comparably high, it is possible to speak about macrocytic anemia (McCance & Huether, 2015). When the mean corpuscular hemoglobin remains to be normal, it is possible to discuss the disease as normochromic anemia.
These terms are used to categorize the pernicious anemia depending on the MCV and MCH levels that are important to be taken into account while discussing the effective treatment.
References
Huether, S. E., & McCance, K. L. (2016). Study guide for understanding pathophysiology. New York, NY: Elsevier Health Sciences.
McCance, K. L., & Huether, S. E. (2015). Pathophysiology: The biologic basis for disease in adults and children. New York, NY: Elsevier Health Sciences.
Yang, D. T., & Cook, R. J. (2012). Spurious elevations of vitamin B12 with pernicious anemia. New England Journal of Medicine, 366(18), 1742-1743.