Pernicious Anemia Case Study: Identifying Through Patient Evaluation

This case study explores the identification of pernicious anemia in a patient (Celine) post-gastric bypass surgery, focusing on key diagnostic questions related to hemoglobin levels, shortness of breath, neurological symptoms, depression, and oral manifestations. The study references published reports and clinical evaluations to justify each question's relevance in diagnosing the condition, highlighting the role of vitamin B12 deficiency and its impact on various bodily functions. Symptoms such as weakness, fatigue, and sore tongue are also considered as indicators, leading to a comprehensive evaluation of Celine's potential diagnosis. Desklib offers more solved assignments and study resources for students.

Running head: PERNICIOUS ANEMIA
Pernicious Anemia
Name of the Student
Name of the University
Author Note

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Table of Contents
Question 1..................................................................................................................................2
Justification............................................................................................................................2
Question 2..................................................................................................................................2
Justification............................................................................................................................3
Question 3..................................................................................................................................3
Justification............................................................................................................................3
Question 4..................................................................................................................................3
Justification............................................................................................................................3
Question 5..................................................................................................................................4
Justification............................................................................................................................4
References..................................................................................................................................5

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Vitamin B12, a water-soluble vitamin is commonly known as Cobalamin and is
provided as supplement along with Vitamin D, iron and calcium in peri-operative conditions.
Deficiency of Vitamin B12 leads to the development of pernicious anemia, a common
phenomenon post gastric bypass surgery (Rolfes, Pinna & Whitney, 2014). During gastric
bypass surgery, the region of the stomach responsible for the secretion intrinsic factor of
VitaminB12 is bypassed. This lack of intrinsic factor prevents the absorption of B12 from the
stomach and thereby giving rise to the disease (Rolfes, Pinna & Whitney, 2014).
The following report aims to highlight five determining questions that will help to
identify whether the patient (Celine) of this case study has actually suffering from pernicious
anemia.
Question 1
Have you conducted complete blood count (CBC) lately and seen that your hemoglobin count
is less than 12.0g/dL?
Justification
According to the reports published by Bizzaro and Antico (2014), pernicious anemia
is normochromic and macrocytic that causes the reduction in the absolute number of
reticulocytes. For the patients who are suffering from pernicious anemia have abnormally low
level of hemoglobin (3 g/dL). However, in the majority of the women suffering from
pernicious anemia, the hemoglobin level remains below 12 to 7 g/dL.
Question 2
Are you suffering from shortness of breath of lately?

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Justification
Pernicious anemia results in the destruction in the reticulocytes and this result in the
subsequent destruction of hemoglobin. The heme-ring of the hemoglobin contain iron as it is
the hem ring where the oxygen is attached and is delivered to different organs of the body
(Voet, Voet and Pratt, 2013). Reduction in the number of hemoglobin leads to the reduction
in the iron content of the body and thereby reducing the oxygen carrying capacity of the
blood, leading to the generation of breathlessness (Reynolds, 2014; .
Question 3
Are you suffering from any neurological symptoms like difficulty in maintaining body balance
or lack of co-ordination in hands and feet?
Justification
Metabolism of folic acid and vitamin B12 is intertwined such that the deficiency of
vitamin B leads to the generation of megaloblastic anemia. The neuronal manifestations of
folate deficiency juxtapose with the vitamin B12 deficiency leading to cognitive impairment
along with other mental health complications like depression, dementia along with peripheral
neuropathy.
Question 4
Are you suffering from depression?
Justification
Deficiency of vitamin B tampers the folate metabolism and this again leads to the
increase in the level of homocystenine. High level of homocysteine leads to the development
of dementia along with depression. Even though folate deficiency is secondary towards the

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psychotic complications, it may accelerate the underlying disorder in a vicious circle effect
(Reynolds, 2014).
Question 5
Apart from sore tongue, are you also suffering from mouth ulcers like ulcer inside the
cheeks?
Justification
Clinical evaluation or pernicious anemia revealed paleness and dry lips. The patients
also suffer from disturbance of taste as she is unable to sense the flavor. Oral examination of
patients with pernicious anemia revealed pale oral mucosa, glossitis along with papillary
atrophy. It is also associated with numerous areas of painful erythema present on the dorsal
surface on the lateral border to te tongue and buccal mucosa (Stabler, 2013).
Furthermore, the exhibited symptoms of Celine like weakness, fatigue along with sore
tongue are few other notable symptoms of pernicious anemia. Expression of these symptoms
and the recommended Vitamin B12 supplement taken by Celine, give indications towards the
susceptible development of pernicious anemia (Rolfes, Pinna & Whitney, 2014).

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References
Bizzaro, N., & Antico, A. (2014). Diagnosis and classification of pernicious
anemia. Autoimmunity reviews, 13(4-5), 565-568.
Reynolds, E. H. (2014). The neurology of folic acid deficiency. In Handbook of clinical
neurology (Vol. 120, pp. 927-943). Elsevier.
Rolfes, S. R., Pinna, K., & Whitney, E. (2014). Understanding normal and clinical nutrition.
Cengage Learning.
Stabler, S. P. (2013). Vitamin B12 deficiency. New England Journal of Medicine, 368(2),
149-160.
Voet, D., Voet, J.G. and Pratt, C.W., 2013. Fundamentals of biochemistry (pp. 408-409).
New York: Wiley.

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