Medical Surgical Pernicious anemia #4

Question

The nurse is caring for four clients on the med-surg floor. Which client is at most risk for pernicious anemia?

Answers

  1. A 45-year-old male with Crohn’s disease admitted with ileocolitis.
    • Rationale:

      This answer is correct because this client has two risk factors. The client has Crohn’s, which is an inflammatory bowel disease that is autoimmune in nature and the client is experiencing an exacerbation through ileocolitis. Since B12 is absorbed from the ileum in the presence of intrinsic factor, the inflammation of the ileum will cause decreased production of the intrinsic factor protein. This can ultimately result in pernicious anemia.

  2. A 67-year-old male with diabetes admitted for a gastrointestinal bleed.
    • Rationale:

      This answer is not correct because even though the client has an autoimmune disease in diabetes, he is experiencing a GI bleed. A GI bleed causes iron-rich blood loss, which leads to iron-deficiency anemia, not pernicious anemia.

  3. An 18-year-old male receiving chemotherapy for leukemia.
    • Rationale:

      This answer is not correct because blood loss associated with clients undergoing chemotherapy is caused by aplastic anemia. This is due to damage to the hematopoietic stem cells and bone marrow from the chemotherapy.

  4. A 22-year-old female with anorexia nervosa.
    • Rationale:

      This answer is not correct because a client with anorexia most likely will have developed anemia due to dietary deficiencies from malnutrition. A diet low in iron, folate, and vitamin B12 increases someone’s chances of developing iron-deficiency anemia or a B12 deficiency unrelated to intrinsic factor.

Overview

Pernicious anemia is caused by an autoimmune process that makes a client unable to produce intrinsic factor. Those at most risk are clients with autoimmune diseases and those at risk for malabsorption of vitamin B12 due to lack of intrinsic factor.

Explanation

Learning Outcomes

Pernicious anemia is caused by an autoimmune process that makes a client unable to produce intrinsic factor. Those at most risk are clients with autoimmune diseases and those at risk for malabsorption of vitamin B12 due to lack of intrinsic factor. Intrinsic factor binds vitamin B12 so that it can be absorbed in the intestines. B12 is specifically absorbed from the ileum in the presence of intrinsic factor. So a diseased ileum can result in pernicious anemia. GI bleeds and clients with malnutrition or dietary deficiencies are at most risk for iron-deficiency anemia, or a vitamin B12 deficiency unrelated to intrinsic factor. The client undergoing chemotherapy or radiation has likely experienced damage to the bone marrow. Damage to the bone marrow results in poor red blood cell production, and this causes aplastic anemia.

Test Taking Tip

Have knowledge of the different types of anemia and their causes. Also specifically, the intrinsic factor vs. vitamin B12 deficiency that can be unrelated to intrinsic factor.

Video Rationale