Mr. Alvis, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and...

Mr. Alvis, 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.
Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.
Discuss other tests that could be performed to diagnose this type of anemia.
Discuss the treatment available and the limitations.

Expert Solution

1) As we know our body needs to function properly to live. Autoimmune diseases causes many problems in our body.

Vitamins B12 is necessary for the function of our body. When our body is unable to absorb vitamin B12 then production of erythrocytes will be impaired. This causes pernicious anemia. Intrinsic factor is produced by parietal cells. Intrinsic factor in our body is responsible for the absorption of vitamin B12, but when our body is unable to produce intrinsic factor or when intrinsic factor does not bind with vitamin B12 then pernicious anemia occurs. When a person is affected with pernicious anemia then they will experience with clumsiness, tingling feeling in toes,fatigue, nausea, diarrhea, sore and swollen tongue.

2) Intrisic factor is produced by parietal cells in the stomach. Intrinsic factor is necessary for the absorption of vitamin B12 in our body. If any gastric abnormalities occur then it may lead to loss of parietal cells which in turn result in vitamin B12 deficiency. Vitamin B12 is absorbed by intrinsic factor. Pernicious anemia is causes the destruction of intrinsic factor. So, when there is not intrinsic factor there will be no absorption of vitamin B12 which will causes vitamin B12 deficiency.

3) Iron binding capacity tests, methylmalonic acid test, serum folate test, combined binding luminescence test, complete blood count, IF and parietal antibodies test, Iron test are some of the tests which are used to diagnose pernicious anemia.

4) Treatment include vitamin B12 injections, and pills,. Limitations include the treatment should be life long and it will never completely cured.

Nightingale answered 1 year ago

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