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Pernicious Anemia
Mr. Alvis, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B12 were below normal. Additional tests confirm pernicious anemia.
Question 1: Relate the pathophysiology of pernicious anemia to the manifestations listed above.
Question 2: Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia.
Question 3: Discuss other tests that could be performed to diagnose this type of anemia.
Question 4: Discuss the treatment available and the limitations.
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