Pernicious Anemia Nursing, Pathophysiology, Symptoms, Treatment | Anemia Types NCLEX

Hey everyone, it's Sarah with RegisteredNurseRN.com, and in this video I'm going to be doing an

NCLEX review over pernicious anemia.

This video is part of an NCLEX review series over hematology, so if you're studying that

material, be sure to check out those videos.

What I'm going to be doing in this video is I'm going to be covering the patho, how it's

diagnosed, the signs and symptoms, and the nursing interventions for pernicious anemia.

And as always, over here on the side or in the description below, you can access the

quiz and the notes.

So let's get started.

First let's start out talking about what is pernicious anemia.

Pernicious anemia is a form of vitamin B12 deficiency anemia that is an autoimmune condition

where the body does not produce enough intrinsic factor.

An intrinsic factor plays a huge role in how your GI system absorbs vitamin B12.

So let's talk about the pathophysiology.

Okay, your body needs vitamin B12 to make healthy red blood cells.

And red blood cells play a big role in carrying oxygen through your body to your organs and

your tissues.

So if you don't have enough red blood cells, you're going to have anemia.

There's various forms of anemia.

Previous video we talked about iron deficiency anemia.

So what happens, you have low amounts of oxygen going through that blood and the body suffers

because it doesn't like that.

So what happens is that your nervous system and your cardiac system are really hurt by

this.

And we'll talk a little bit more about that here in a second.

Now what is intrinsic factor?

Intrinsic factor is a protein that helps your body absorb vitamin B12.

So what happens is that intrinsic factor is a protein.

You take vitamin B12 in through food.

That's the only, that's only how you can get it.

Your body does not produce vitamin B12.

So you eat some foods with vitamin B12.

Intrinsic factor protein gets that vitamin B12 and releases it into the gastric secretions

to be absorbed.

And your parietal cells is what is responsible in your gut for producing this intrinsic factor.

And vitamin B12 is mainly absorbed by your ileum in your stomach.

So in pernicious anemia what happens, it's an autoimmune condition.

So what happens is that the body starts to produce antibodies that attack those parietal

cells.

So they become attacked, they can't do their job and release intrinsic factor.

So you don't absorb enough vitamin B12 and you get low levels and then you start making

these really unhealthy red blood cells.

So why does this happen?

The total cause is unknown.

However, it can be genetic and run in families and the elderly can have an issue with this.

I know in geriatric nursing you've probably learned about how the elderly have low vitamin

B12 levels.

And this is due to decreased acid production.

The older you get, the less acid you produce, hence the less intrinsic factor you'll produce.

Also patients who struggle with endocrine disorders like Addison's, thyroid problems,

diabetes type 1 can experience this.

Or patients who have GI diseases or have had stomach surgery that destroy the parietal

cells which in turn will decrease your production of intrinsic factor.

Now let's talk a little bit about how these red blood cells will appear.

So whenever you have low B12, what happens is that your red blood cells start to turn

very large and they are oval shaped compared to this over here.

These are normal.

They're nice and round.

They're normal shaped.

And what happens is that your bone marrow produces your red blood cells along with many

other things.

So your bone marrow releases it into the blood.

But in pernicious anemia, these red blood cells are very big.

They're not dividing properly.

So what happens is that your bone marrow decreases production of it.

So you get pernicious anemia.

Now let's talk about how low B12 affects the body and how low red blood cells affect the

body.

Okay.

With low B12, major signs and symptoms which you're going to see here in a second, you're

going to see nervous system changes with B12.

It's really one of the big things that can differentiate it from the other types of anemia.

What happens is when you have low vitamin B12 levels, you get irreversible damage to

nerve cells.

So the patient may start experiencing paresthesia, which is tingling or burning sensation in

those extremities, like the hands and the feet.

Very uncomfortable.

Also, they can experience clumsiness because of that.

You have tingling and burning sensations on your feet.

It throws off your walking and you can become unsteady.

Also, patients can suffer with depression and muscle weakness.

Another thing it wreaks havoc on is your heart.

Because remember, your heart is responsible to providing all your tissues and organs with

oxygen.

And you have low amounts of oxygen in the body because you have messed up red blood

cells and low amounts of them.

So your heart has to work harder to pump that blood throughout the system to get it some

oxygen.

So your heart can only take so much.

So it gets weak, it can enter into heart failure.

Another thing that's affected is your GI system.

Whenever you have pernicious anemia, the patient may have a very red, beefy, swollen, smooth

looking tongue.

And it's from the decreased oxygen going to the tongue.

So that's going to mess up their taste.

Food's not going to taste as good, may be painful.

Also, they can have an upset stomach from where the stomach lining is starting to thin.

And it increases their risk of stomach cancer, people who have pernicious anemia.

Now how is this diagnosed?

Usually through blood tests.

There's various blood tests a physician can order.

As a nurse, you need to be familiar with them.

Like a complete blood count, also known as a CBC, will look at the red blood cells, hemoglobin,

hematocrit, peripheral blood smear.

This is where it will actually look at those red blood cells under a microscope and they'll

have that appearance of looking very large and oval shaped, rather than normal size and

round.

Also, a doctor can check the vitamin B12 level or an intrinsic factor assay.

Or they can order, which isn't a blood test, they can order a bone marrow aspiration and

biopsy.

The bone marrow, aspirate that stuff out and look at that.

Now let's look at the signs and symptoms that you can see in pernicious anemia.

Now these signs and symptoms tend to happen over time as the body is depleted of vitamin

B12.

Because a lot of vitamin B12 is stored in your liver and most in your liver and in your

muscles.

So it'll happen gradually.

The patient may think it's something else, they're just tired or something like that.

But to help you remember the signs and symptoms, remember the word pernicious, because we're

talking about pernicious anemia.

So the signs and symptoms that have the little brown asterisks by it, that is the big signs

and symptoms that you're going to see in pernicious anemia.

Because remember, vitamin B12 causes a lot of problems with the nervous system and the

tongue.

Okay, so P, they're going to be palor, because they have low oxygen in the body, so they

may appear more white than normal.

E, energy gone, they're going to be very fatigued and tired, and that is due to the low amounts

of oxygen in the body.

R for red smooth tongue, again, like I said, that's due to that decreased blood flow to

the tongue, it's going to cause it to look that beefy red.

And N for numbness slash tingling in the hands or feet, and that's that paresthesia that's

caused from that nerve damage of having the low B12.

I for intestinal issues, because remember their GI lining is starting to thin, so they

can get abdominal bloating, they can have diarrhea or constipation and indigestion.

C for confusion, I for increased sadness, they'll struggle with depression.

And the O in the word loss, loss of appetite, which can lead to weight loss, and this is

due to the GI upset and the tongue changes, food just doesn't taste like it normally does.

U for unsteady gait, which we can trace back to the numbness and tingling they can feel

in the feet.

And then S for shortness of breath with activity they can normally tolerate, and that's because

of the low oxygen levels because of the decreased red blood cells.

Now what are the nursing interventions, what are you going to do for this patient as the

nurse?

Okay, the goal is to replace the patient's vitamin B12.

Now the patient cannot, you can tell them to eat all the vitamin B12 they want all day,

tell them about rich foods, but it's just not going to help because why?

They don't have that intrinsic factor to take that B12 and release it in the gastric secretion

so the ileum can absorb it.

So we're not going to give them vitamin B12 and a pill through the mouth because it's

not going to work, because it's going to go in the GI system and it's not going to do

its job.

So they needed another route.

So the doctor would probably order you to give vitamin B12 injections, which is normally

given IM, intramuscularly.

And first, depending on how severe it is, they'll start out with weekly injections of

vitamin B12 and then progress to monthly.

And if they have this really bad, they may have to do this for life.

So they're absorbing vitamin B12.

Also, if they're really, really low in red blood cells, they may need a blood transfusion.

So you'll be responsible as a nurse for doing that.

And you'll want to educate the patient on safety due to that paresthesia that they have

in their hands and on their feet and being unsteady, confused at times.

So they want to make sure they're watching how they walk.

You want to educate them on eating foods high in iron, vitamin C, and folic acid, because

even though eating foods rich in vitamin B12 will be great, but they can't really absorb

it.

But other types of anemia, like iron deficiency anemia, they don't eat enough foods in iron

and vitamin C, because iron and vitamin C go together.

The vitamin C helps you absorb iron.

You can also get iron deficiency anemia, because it plays a role.

Iron plays a role in making red blood cells.

And folic acid does as well.

So you want to educate them about that.

And how to do good oral hygiene, because the tongue has changes.

Okay, so that is about pernicious anemia.

Now go to my website, registernursern.com, and take the free review quiz that will test

you on this knowledge that you just learned.

And be sure to check out the other videos in this series.

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