Pernicious Anemia

Introduction

The body is unable to absorb Vitamin B12, which is needed to make RBC, result-
ing in a decreased RBC count. More common in people of northern European
descent, the anemia typically develops in adulthood. The intrinsic factor is nor-
mally secreted by the parietal cells of the gastric mucosa and are necessary to
allow intestinal absorption of vitamin B12. Destruction of the gastric mucosa due
to an autoimmune response results in loss of parietal cells within the stomach. The
ability of vitamin B12 to bind with intrinsic factor is lost, decreasing the amount
that is absorbed. Typical onset is between the ages of 40 and 60.

SIGNS AND SYMPTOMS

• Pallor due to anemia
• Weakness and fatigue due to anemia
• Tingling in hands and feet—“stocking-glove paresthesia”—due to bilateral
demyelination of dorsal and lateral columns of spinal cord nerves
• Diminished vibratory and position sense
• Poor balance due to effect on cerebral function
• Dementia appears later in the disease
• Atrophic glossitis—beefy red tongue
• Nausea may lead to anorexia and weight loss
• Premature graying of hair




TREATMENT

Lifelong replacement with vitamin B12 will correct the anemia and improve the neu-
rologic changes that have occurred. Initially the patient is given weekly injections of B12 to combat the deficiency. The injections eventually become monthly for lifelong
maintenance. Oral supplementation is not effective in these patients because they
cannot adequately absorb vitamin B12 due to insufficient intrinsic factor.
• Administer vitamin B12 by IM injection.
• Transfusion of packed RBC if anemia is severe.


NURSING DIAGNOSES

• Impaired gas exchange
• Imbalanced nutrition, less than what body requires
• Risk for injury

NURSING INTERVENTION

• Prevent injuries.
• Explain to the patient:
• Use soft toothbrush due to oral changes.
• Avoid activities that could lead to injury due to paresthesias or changes in
balance.
• Inspect feet each day for injury due to paresthesia.