Read the statement below and respond. In your response discuss other potential therapies available for this individual. Explain the pathophysiology behind the development of this type of anemia.
Anemia is defined as a “…reduction in the total circulating red cell mass or a decrease in the quality of hemoglobin” (McCance & Huether, 2019 p.926). There are several causes of anemia including “…blood loss, impaired erythrocyte production, increased erythrocyte destruction, or a combination of these factors” ( McCance & Huether, 2019, p. 926). There are also several different types of anemia including megaloblastic, which can be further broken down to pernicious anemia and folate deficiency anemia. In pernicious anemia, there is an absence of intrinsic factor, “…which is required for vitamin B12 uptake from the gut” (McCance & Huether, 2019, p. 932). Intrinsic factor, or IF, is the “…protein transporter necessary for absorption of vitamin B12 in the intestine” (McCance & Huether, 2019, p. 932).
Research has shown that being female, of advanced age, and from Northern European countries increased the risk of developing pernicious anemia. Many of the women diagnosed “…have prematurely grey hair and blue eyes, have blood group A and may develop or have already developed other autoimmune disorders, including vitiligo, thyroid disease such as autoimmune thyroiditis and hypothyroidism and Addison’s disease” (Gilbert, 2017). This condition is also frequently associated with polyendocrinopathy, “…a cluster of autoimmune diseases of endocrine organs” (McCance & Huether, 2019, p. 932) such as type 1 diabetes, Graves disease, myasthenia gravis, and Hashimoto thyroiditis. Other risk factors include smoking, excessive alcohol intake, pregnancy, and surgical removal of sections of the stomach.
Symptoms of pernicious anemia are often gradual and include “…lethargy, paraesthesis in the extremities, especially the feet, muscle weakness, depression, problems with memory, understanding and judgement, difficulty in gait, and visual disturbances” (Gilbert, 2017). Treatment for this condition includes “…lifelong therapy with replacement B12” (Gilbert, 2017). This is generally achieved via intramuscular injections that start frequently and gradually decrease as levels stabilize. After stabilization of levels, some patients may be transitioned to oral B12 supplementation, but risks associated with this course of treatment include poor compliance and an increased risk for improper absorption.
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