Case Study: Diagnosis and Treatment of Pernicious Anemia

This case study presents a 60-year-old patient, Jane, diagnosed with pernicious anemia. The case details her presenting symptoms, including tiredness, nausea, and yellow skin, along with her health history, vital signs, and physical assessment findings. Diagnostic lab results reveal low hemoglobin, high WBC, high ESR, and high bilirubin levels, confirming pernicious anemia. The pathophysiology of the condition, caused by vitamin B12 malabsorption due to a lack of intrinsic factor, is explained. The document also includes a diagrammatic representation of the deficiency and a molecular description of RBC DNA synthesis and the effects of cobalamin deficiency. The recommended treatment involves intramuscular hydroxycobalamin injections. The case study is supported by references to relevant medical literature.

A Case Study of a
Patient With Pernicious
Anemia
Name:
Institution
Affiliations:
Instructor:

Introduction
Information on Patient
 Jane-60 year old
 White American Widow
 Mother of 3 and grandma of 3
 Middle class
 High school teacher

Presenting Symptoms
 Tiredness
 Nausea
 Yellow skin
 Dizziness
 Shortness of breath
 frequent headaches
 Exertional dyspnea
 Signs: Congestive heart failure

Health History
 Diagnosed with Anemia 2 years ago
 Prescribed Oral Iron=No
improvement
 Lost 11lbs( from187lbs to176lbs)
 Denied dysphagia & dyspepsia
 Premenopausal blood loss at
menstruation
 Non-Smoker
 Drinks Alcohol

Prior Hospitalization
 Gynecological history shows
dysmenorrhea
 Menses extended beyond 7 days
 Heavy blood flow
 Underwent Cesarean Section at first
pregnancy
 Took Iron booster pills with no recall of
diagnosis
 Diagnosed with Pernicious Anemia

Patient’s Health
Statistics
Vital Signs
Sign Measure
Temperature 98.4 Degrees Fahrenheit,
BP 138/87mmHg,
Respiratory rate 26 breaths /minute
Heart Rate(HR) 102 beats/minute

Physical Assessment
Findings
 Completely clear Sclera
 Sclera is icteric
 Heart beat higher than normal
 Tachypneic
 Has tachycardia
 Clear heart beats=no obstruction
 Swollen ankle+tenderness
 Abdomen: not tender/no masses/no
organomegaly

Diagnostic Lab Test
Results
Lab Diagnostic Test
Components of
Blood
Results Normal Index
range
Hemoglobin 5.4g/dl 11.5-16.0g/dl
Mass cell volume 107fl 98-120fl
WBC 7.1g/dl 4.0-5.5g/dl
Platelets 132*100/L 150-400100/L
ESR 26mm/hr. 0-30mm/hr.
Bilirubin 59micromol/L 3-17micromol/L

Interpretation of Test Results
 Low Hb of 5.4g/dl=decreased hematocrit & RBC
levels
 Highly WBC count (7.1g/dl)=Infection &
Inflammation+ Autoimmune disorder (Dobrozsi
et al., 2013).
 Low PLT=Bone marrow not producing enough
PLT
 High ESR of 26mm/hr.=Infection &
Inflammation
 High bilirubin levels=Hepatic hemolysis of RBCs
(Odi, 2009)
 Conclusion: Patient has pernicious Anemia

Pathophysiology of Pernicious Anemia
 Caused by RBC production impairment
 Impairment due to malabsorption of Vit
B12(Bizzaro & Antico, 2014)
 Pernicious anemia patients lack IF
 IF secreted by parietal cells
 Inhibited parietal cell function=No IF
 IF absence=No absorption of Vit
B12(Diamantino et al., 2012)
 Vitamin B12 absence=Production of
immature RBCs

Diagrammatic Representation of Vit
B12 Deficiency
No IF=No
B12
Absorptio
n
DNA
synthesis
impairme
nt in bone
marrow
Immature
RBC
Nuclei=fo
rm
Megaloba
lsts
Megalobl
asts
destroye
d/Some
mature
to
Macrocyt
es
Low
RBC(Ane
mia)

Molecular Description of RBC DNA
Synthesis
 Animals convert B12 to coenzyme
adenosylcobalamin & methylcobalamin (Riyach,
2014)
 Adenosylcobalamin converts L- methylmalonic acid
to succinyl coenzyme A
 Methylcobalamin triggers homocysteine to
methionine conversion
 Thymidine synthase impairment results from
folate/cobalamin deficiency (Lindgren, 2009)
 Megaloblastic changes occur
 Ineffective erythropoiesis occurs in the erythroid
precursors
 Results: Low RBC=Pernicious Anemia

Description of vit B12 Malabsorption
 Milk+Meat are cobalamin sources
 Released cobalamin in diet bind to IF
 Cobalamin-IF complex recognized by ileal cublin
receptors
 Cobalamin released into portal circulation binds to
transcobalamin II (TCII) (Odin, 2009)
 Complex is endocytosed & degraded in lysosome
releasing cobalamin
 Cytoplasmic methylation reduces cobalamin to
methylcobalamin (Bonsdorff & Gordin, 2009).
 Mitochondrial adenosylation of cobalamin forms
adenosylcobalamin

Effects of Cobalamin/vit B12
Deficiency
 Impaired development in children
 Mental retardation
 Macrocytic anemia
Conclusion:
 Jane has pernicious anemia
 Recommended medication: Intramuscular
hydroxycobalamin injections administered
at 3 moth interval (Riyach, 2014)
 This will improve the patient’s reticulocyte
count.

References
 Bizzaro, N., & Antico, A. (2014). Treatment of pernicious anemia: Which is the best
option?. Autoimmunity Reviews, 13(7), 779. http://dx.doi.org/10.1016/j.autrev.2014.02.001
 Bonsdorff, B., & Gordin, R. (2009). Oral Administration of Vitamin B 12 in Pernicious Tapeworm
Anemia. Acta Medica Scandinavica, 139(S259), 112-122. http://dx.doi.org/10.1111/j.0954-
6820.1951.tb13236.x
 Diamantino, F., Diamantino, C., Mascarenhas, A., & Lopes, M. (2012). Reversible generalized
cutaneous hyperpigmentation: presenting manifestation of pernicious anemia. International
Journal Of Dermatology, 51(7), 845-847. http://dx.doi.org/10.1111/j.1365-4632.2011.05124.x
 Dobrozsi, S., Flood, V., Panepinto, J., Scott, J., & Brandow, A. (2013). Vitamin B12 deficiency: The
great masquerader. Pediatric Blood & Cancer, 61(4), 753-755.
http://dx.doi.org/10.1002/pbc.24784
 Lindgren., G. (2009). Macrocytosis in Acute Hepatitis and Pernicious Anemia. A Comparison
Based on 830 Price-Jones' Curves. Acta Medica Scandinavica, 136(1), 39-50.
http://dx.doi.org/10.1111/j.0954-6820.1950.tb09613.x
 Odin, M. (2009). A New Stomach-Liver Preparation for the Treatment of Pernicious Anemia. Acta
Medica Scandinavica, 108(5), 466-481. http://dx.doi.org/10.1111/j.0954-6820.1941.tb18808.x
 Riyach, O. (2014). Neurogenic Bladder Revealing a Pernicious Anemia: One Case Report and
Literature Review. Clinical Medicine Research, 3(3), 61.
http://dx.doi.org/10.11648/j.cmr.20140303.12
 SERUM VITAMIN B12 BINDERS AND HUMAN MARROW CELL UPTAKE OF 57Co-VITAMIN B12.
(2009). Nutrition Reviews, 31(9), 277-279. http://dx.doi.org/10.1111/j.1753-
4887.1973.tb07064.x