Alterations in Oxygen Transport
Deb Smith, age fifty-six, came to her nurse practitioner (NP) with fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high; and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.
Answer the following questions regarding Deb’s anemia and provide the pathophysiology associated with the body’s response to this disease process.
- Why should Deb’s NP ask her about paresthesia and ataxia?
Deb Smith, a 56-year-old patient, presented to her nurse practitioner with symptoms of fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report revealed low levels of hematocrit, hemoglobin, and reticulocyte counts, high mean corpuscular volume (MCV), and normal mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC). Deb was diagnosed with pernicious anemia, which is caused by a deficiency of vitamin B12. Pernicious anemia is often associated with chronic congenital or autoimmune gastritis and is commonly referred to as megaloblastic anemia. The term “pernicious” signifies something that is very injurious or destructive. In this case, the body’s response to pernicious anemia involves impaired oxygen transport due to the deficiency of vitamin B12, which is essential for the production of healthy red blood cells.
- Why did her NP prescribe vitamin B12 by intramuscular injection rather than orally?
The nurse practitioner prescribed vitamin B12 by intramuscular injection instead of orally because oral administration of vitamin B12 was not effectively absorbed due to the lack of intrinsic factor (IF) to facilitate absorption. Intrinsic factor is a protein produced in the stomach that binds to vitamin B12 and allows it to be absorbed in the small intestine. Without IF, the body cannot absorb vitamin B12 efficiently through the oral route. However, it is believed that a higher dose of oral vitamin B12 can be absorbed across the small bowel and still provide benefits. Therefore, the decision to administer vitamin B12 by intramuscular injection was made to ensure adequate absorption and therapeutic effect.
- What causes pernicious anemia?
- What are the technical terms that describe anemia with high MCV and normal MCH?
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