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Case Study: Blood and Circulatory System Disorders

Mr. X, 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.

Discussion Questions

1. Relate the pathophysiology of pernicious anemia to the manifestations listed above. (See Pernicious Anemia.)

2. Discuss how the gastric abnormalities contribute to vitamin B12 and iron deficiency and how vitamin B12 deficiency causes complications associated with pernicious anemia. (See Pernicious Anemia—Pathophysiology, Etiology.)

3. Discuss other tests that could be performed to diagnose this type of anemia. (See Pernicious Anemia—Diagnostic Tests.)

4. Discuss the treatment available and the limitations.


The symptoms of pernicious anemia include tingling in hands and feet, a bright red or smooth tongue and a feeling of weakness. Mr. X symptoms correspond to those of anemia. The test used by the pathophysiology was a complete blood count to measure the cells concentration in blood.

According to Stifter, Heiss, Gastl, Tzankov, and Stauder (2005), the gastric abnormalities such as vomiting, constipation, diarrhea, and nausea are caused by the iron deficiency. Inflammation of the stomach and Helicobacter pylori GI infection reduce the absorption of iron from the GI track (Stifler et al., 2005, p.486). Moreover, the stomach abnormalities lower the production of an intrinsic factor that is vital for the absorption of vitamin B 12 preventing pernicious anemia.

Food containing high quantity of Vitamin B 12 comprises a significant amount of iron. Therefore, a lack of vitamin B 12 often refers to a lack of iron causing anemia. The prevention of the two types of anemia involves consuming food rich in both iron and vitamin B 12. The last one helps to produce red blood cells in the body preventing a nerve damage.

Additional diagnosis includes the bone marrow test. The aspiration and biopsy bone marrow test determine the ability of the bone marrow to make healthy cells. In the biopsy test, bone tissues get removed while in the aspiration, little fluid is obtained from the bone marrow. In both tests, in a condition of pernicious anemia, blood cells become larger than usual when viewed under the microscope.

The treatment of anemia involves the oral intake of iron supplements and Vitamin B 12. According to Dror and Allen (2008), the absorption of iron best proceeds in the stomach because of acidic media. The iron supplements include ferrous fumarate that contains 106mg of iron in each tablet and ferrous gluconate containing 36mg of iron per tablet (Dror & Allen, 2008, p.253). The limitation of oral iron supplements intake is usually get affected by GI side effects such as nausea, diarrhea, constipation, and vomiting. Therefore, the iron supplements get injected in body muscles. Moreover, the treatment of the vitamin B12 deficiency does not result in resolving the lack of iron unless the patient consumes the products with a higher quantity of heme iron (Dror & Allen, 2008, p.254).

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