This is an NCLEX review for pernicious anemia. Patients with pernicious anemia have low levels of red blood cells due to low levels of vitamin b 12.
In the previous review, I covered other hematology disorders. So, if you are studying for NCLEX or your nursing lecture exams be sure to check out that section.
When taking care of a patient with pernicious anemia it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, how it is diagnosed, nursing interventions, and patient education.
Don’t forget to take the pernicious anemia quiz.
In this NCLEX review for pernicious anemia, you will learn the following:
-Definition of pernicious anemia
-Pathophysiology of pernicious anemia
-Signs and Symptoms
Lecture on Pernicious Anemia
Pernicious Anemia NCLEX Review
What is Pernicious Anemia?
Pernicious anemia is a form of vitamin b 12 anemia that is an autoimmune condition where the body does not produce intrinsic factor, which plays a role in absorbing vitamin b 12.
Pathophysiology of Pernicious Anemia
The body needs vitamin b 12 to make healthy red blood cells. A protein called intrinsic factor plays a role in the body’s ability to absorb vitamin b 12. Vitamin b12 is not produced by the body but is taken in through food with the help of a protein called intrinsic factor. In pernicious anemia, there isn’t enough INTRINSIC FACTOR to help with absorption of vitamin b 12 in the stomach (total cause unknown but can be due to stomach surgery or GI disease etc).
How does intrinsic factor help the body absorb vitamin b 12? It attaches to the vitamin B 12 found in the food you consume and releases it into the stomach acid. Then the vitamin b 12 is absorbed by the ileum. The parietal cells in the stomach produce intrinsic factor and can become damaged from an autoimmune response in the system. Antibodies attack the parietal cells which damages them to the point where they cannot produce intrinsic factor. GI disease and stomach surgery can destroy parietal cells which decrease the production of intrinsic factor.
What happens to the red blood cells in the pernicious anemia? If vitamin b 12 levels are too low this can lead the body to produce unhealthy red blood cells. Instead of the RBCs being normal sized and round, they become large and are shaped like an oval (also called macrocytic anemia…learn about microcytic anemia in iron-deficiency anemia).
This in turn causes the bone marrow (which in responsible for producing RBCs) to produce less of them and the RBCs have a hard time leaving the bone marrow because they are too big and don’t divide properly.
Red blood cells play a HUGE role in carrying oxygen throughout the body to organs and tissues, but if there aren’t enough RBCs the body doesn’t receive enough oxygen. In pernicious anemia, there are low amounts of RBCs and organ systems start to suffer, especially the heart and neuro system.
How low vitamin b 12 and low RBCs affect the body?
- Nervous System (majorly affected in pernicious anemia): low vitamin b 12 causes irreversible damage to nerve cells so the patient can experience paresthesia.
- Heart: it has to work harder to pump blood to get oxygen to the organs and tissue which can eventually lead to heart failure.
- Intestinal: tongue changes from decreased oxygen and the stomach lining begins to thin which can cause an upset stomach and increase risk of stomach cancer.
Risk Factors for Pernicious Anemia
- Aging: older adults can experience this due to decreased production of gastric acid and intrinsic factor.
- Autoimmune disease of the endocrine system: Addison’s, Diabetes Type 1 etc.
How is Pernicious Anemia Diagnosed?
- CBC: to measure RBCs, hgb, hct
- Blood smear to look at RBC (will appear large and oval)
- Vitamin b12 level
- Intrinsic factor antibody assay
- Bone marrow aspiration and biopsy
Signs and Symptoms of Pernicious Anemia
Signs and symptoms may take a while to be noticed by the patient.
*=most common in pernicious anemia
Remember the mnemonic: Pernicious
Energy gone (very fatigued)*
Red, smooth tongue*
Numbness or tingling in hands and feet*
Intestinal issues (abdominal bloating, diarrhea/constipation, indigestion)
Increased sadness (depression)
lOss of appetite (taste changes and weight loss)
Unsteady gait (clumsy)
Shortness of breath with activity
Nursing Interventions for Pernicious Anemia
Goal replace vitamin b 12 (patient can’t receive vitamin b 12 from food…so they will need it a different route)
- Administer vitamin b 12 injections (intramuscular….not orally because they aren’t absorbing it in the GI system) as ordered by doctor. Regime is usually weekly at first and then monthly for maintenance (for lifetime)….if severe anemia will need blood transfusion
- Educated on safety: due to risk of injuries from unsteady gait…more clumsy from the paresthesia
- Educate about importance of eating enough foods with iron, vitamin C, and folic acid because these nutrients play a role in red blood cell production as well.
- Maintain good oral hygiene due to changes to tongue.
More NCLEX Reviews
- What Is Pernicious Anemia? – NHLBI, NIH. (2011). Nhlbi.nih.gov. Retrieved 1 December 2016, from https://www.nhlbi.nih.gov/health/health-topics/topics/prnanmia/