Question

An 84 year old wow comes to the clinic complaining of fatigue, numbness and tingling in his hands and feet and noticed some problems with his gait. He is worried that she might have had a stroke . The widow has complained of "aching joints" and takes over the counter pain medication medication (NSAID-nonsteroid anti-inflammatory drug) four times a day.
he lives alone and the family lives 6 hours away and only visits few months. The widow has difficulty making meals and stated since his spouse died that his appetite is poor. her meals usually consist of toast and tea for breakfast, 1/2 sandwich for lunch, a frozen dinners.
upon exam the doctor suspects the patient may be anemic
1. what type of anemia causes fatigue, numbness and tingling sensation in hands and feet with unsteady gait?

2. what other information would you like to ask the client regarding diet?

3. what anemia types are possible for this client and why?

4. which lab test would be completed to determine the correct anemia diagnosis for the widow. specify what each lab test helps identify and why it would be performed.

Answer 1

1) PERNICIOUS ANEMIA

Pernicious Anemia occurs due to deficiency of vitamin-B12

* vitamin-B12 deficiency leads to fatigue,numbness,tingling sensation and feet with unsteady gait and trouble walking

2) other information regarding diet

I would ask the client

* That she is taking any animal products like milk,milk products and fish, meat,eggs or not.because these animal products contain good amount of vitamin b12 and also iron.

* And I would also ask that she is taking any dark green leafy vegetables such as spinach and peas,beans,pork or not because these foods contain rich iron content.

* And I would like to ask that from how many days she is not taking above mentioned type of diet.

* so this is the other diet information I would like to ask the client.

​​​3) PERNICIOUS ANEMIA,IRON DEFICIENCY ANEMIA,

THE BASIC MAIN TYPE OF ANEMIAS OCCUR ARE MEGALOBLASTIC ANEMIA AND MACROCYTIC ANEMIAS

*All these type of anemias occur because of deficiency of vitamin b12 and folate.

*Here client is not taking proper food so lack of nutrients cause different types of anemia

*vitamin b12 deficiency and folate deficiency occurs because she is not taking any sea foods and leafy vegetables ..and mainly non steroidal anti inflammatory drugs (NSAIDS) are one of the causes of iron deficiency anemia.

*Here the client taking NSAID four times a day for aching joints so this leads to iron deficiency anemia

* So all the above mentioned reasons are causes for pernicious anemia and iron deficiency anemia.

4) A) COMPLET BLOOD COUNT:-

Complete blood count checks for the level of hemoglobin.hemoglobin is iron rich protein..so less amount of hemoglobin level indicates the iron deficiency anemia.And also checks the size and number of red blood cells.

B) MMA TEST OR METHYL MALAONIC ACID TEST:-

This test is an early indicator of vitamin b12 deficiency.High level of methyl melanoic acid indicates low level of vitamin b12 .This lab test helps in identifying pernicious anemia.

C) INTRINSIC FACTOR ANTIBODY TEST OR IF ANTIBODY TEST:-

This test confirms the diagnosis of Pernicious anemia caused by vitamin b12 deficiency due to lack of intrinsic factor.intrinsic factor is a glyco protien necessary for the absorption of vitamin b12.