Pernicious Anemia - Mitch

8/2/2019 Pernicious Anemia - Mitch

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PERNICIOUS

ANEMIA

Prepared by:Michelle Anne


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PERNICIOUS ANEMIA

Historical View:

First described in 1849 by Thomas Addison

Was termed fatal and called Pernicious due to

similar symptoms found in Leukemia and Cancer. Dr. George Whipple produced the first cure

for PA which is raw liver.

In 1948 Vitamin B12 was introduced as the main

source of cure of PA patients. Today, the term pernicious is no longer appropriate,

but it is retained for historical reasons
http://www.b12patch.com/blog/wp-content/uploads/2012/01/raw_pork_liver_elevated_view_mu00133.jpghttp://www.b12patch.com/blog/wp-content/uploads/2012/01/5726696933_9fc93893d9.jpg


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PERNICIOUSANEMIA

A.K.A:1. Macrocytic Achylic Anemia

2. Congenital / Juvenile Pernicious Anemia

A rare autosomal recessive indicated as early onset and

presents before age 2 with significantly decreased lowlevels of IF but normal gastric secretions.

3. Megaloblastic Anemia

characterized by the presence of enlarged cells(megaloblasts) due to the impaired cell division


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Definition: A chronic illness caused by impaired absorption of

vitamin B-12 due to a lack of intrinsic factor (IF) inthe stomach.

An adult onset but usually diagnosed around theage of 60

PERNICIOUSANEMIA


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PERNICIOUSANEMIA

Intrinsic Factor: A glycoprotein secreted by

the parietal cells in thestomach lining

Facilitates absorption ofvitamin B12 in the smallintestine

Vitamin B12: Necessary in the formation

of red blood cells

Maintenance of the centralnervous system

Is important for metabolism

Can be found in:

Eggs, meat, shellfish,milk, orange, broccoli,

asparagus, green leafyvegetables, peas,peanuts, beanschickpeas


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PERNICIOUSANEMIA

Causes: Weakened stomach lining (atrophic gastritis)

The body's immune system attacking the cells thatmake intrinsic factor or intrinsic factor itself

Long term use of certain drugs that can reduce theacid in the stomach lining such as metformin, andbiguanides.


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PERNICIOUSANEMIA

Lack of Vitamin B12 in the diet which is

common among vegetarians.

From certain intestinal disorders that interfere with theabsorption of vitamin B12, such as Crohn's disease andintestinal infections.

Surgery such as Gastrectomy or Gastric Bypass for

weight loss


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PATHOPHYSIOLOGY

Precipitating factors:Diet

Surgery Drugs affecting the absorption of vitaminB12

Lack of intrinsic factor in the stomach

Decrease in Vitamin B12

Abnormal red blood cell (Macrocytic)

Hypoxia Pallor

Fatigue Pale nail bed Loss of appetite

Disorientation Irritability

Personality changesDementia

DizzinessHeadacheDiarrheaPoor concentrationShortness of breathWeaknessAltered tasteperception

Beefy red tongue Depression

Loss of balance Memory loss shortterm Numbness or tinglingsensation in arms orlegs

Pernicious Anemia

Weakened gastric lining loss of parietalcells

Decrease in production of Red Blood Cells

Predisposing factors:Age

Race Family History Autoimmune Disorders


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PERNICIOUSANEMIA

Symptoms: Dizziness

Pallor

Fatigue, lack of energy

Diarrhea or constipation

Loss of appetite

Problems concentrating

Shortness of breath

Beefy red tongue - pathognomonic
http://www.b12patch.com/blog/wp-content/uploads/2012/01/dizziness.png


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PERNICIOUSANEMIA

Numbness and tingling of hands and feet

Personality changes

Confusion

Short term memory loss

Dementia Depression

Loss of balance


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PERNICIOUSANEMIA

Diagnostic tests: Complete blood count (CBC)

Reticulocyte count

Serum vitamin B12 level

Bone marrow examination

Schilling test


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PERNICIOUSANEMIA

Treatment: IM B-12 at 1000 mcg daily for one week, then 1000 mcg

weekly for one month, then 1000 mcg every month forone year indefinitely.

Some doctors recommend that elderly patients withgastric atrophy take vitamin B12 supplements by mouthin addition to monthly injections.

There is also a preparation of vitamin B12 that may begiven through the nose.


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PERNICIOUS ANEMIA

Nursing interventions:1. Plan activities, rest periods, and necessary diagnosis

test to conserve the patient energy

2. Monitor pulse rate often.

3. For adequate schilling test results, all urine over 24 hrsperiod should be collected and the specimen notcontaminated with feces

4. Warn the patient to guard against infections and toreport signs of infection promptly


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PERNICIOUSANEMIA

5. Provide well balanced diet, including foods high invitamin B12

6. Avoid giving irritating food since the patients mouthand tongue are sore and painful

7. Warn the patient with sensory deficit not to use aheating pad since it may cause burn


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PERNICIOUSANEMIA

Prognosis:

Pernicious anemia is usually easy to treat with vitaminB12 pills or shots

People with pernicious anemia who get proper lifelongtreatment can have a normal lifespan.

Complications:

People with pernicious anemia may have gastric polyps,and they are at increased risk for gastric cancer and

gastric carcinoid tumors.

Brain and nervous system (neurological) problems maycontinue if treatment is delayed.


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PERNICIOUS ANEMIA

Conclusion:Pernicious anemia is common among the aging.

The disease is a result of impaired absorption ofVitamin B12 due to a deficiency of Intrinsic Factor.

The cause is unknown; it affects multiple systems ofthe human body but if recognized and treated early,all effects are completely reversible.

Although the treatment is lifelong, it is relatively

simple and convenient to the patient.


18/18Thank You!!

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Pernicious Anemia - Mitch