The patient’s nurse practitioner (NP) should inquire about paresthesia and ataxia because these are neurologic abnormalities, which are associated with vitamin B12 deficiency that leads to the development of pernicious anemia. Bizzaro and Antico (2014) argue that these motor symptoms are a sign of “subacute combined degeneration involving the dorsal and lateral spinal columns” (p. 2). Other symptoms of the condition include, but are not limited to, pallor, tachycardia, weakness, and increased irritability (Bizzaro & Antico, 2014).
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The NP prescribed the patient intramuscular injection of vitamin B12 because the oral administration is less effective. It has to do with the fact that being autoimmune gastritis, the condition prevents the vitamin from the absorption in the terminal ileum (Chan, Low, & Lee, 2016). However, the findings of a recent study, which involved two randomized control trials, reveal that oral vitamin B12 replacement can be effective at 1000 μg daily (Chan et al., 2016).
Pernicious anemia is a disease caused by vitamin B12 deficiency that occurs as the result of the deterioration of gastric parietal cells that produce a secretion factor necessary for binding the vitamin. The condition is also associated with autoimmune disorders such as diabetes mellitus and thyroid disease (Chan et al., 2016; Hooper, Hudson, Porter, & McCaddon, 2014).
Anemia that produces a high mean corpuscular volume (MCV) and normal hemoglobin concentrations, which are measured by mean corpuscular hemoglobin (MCH), is referred to as macrocytic-normochromic anemia. The condition is characterized by defective DNA synthesis, which causes abnormally shaped erythrocytes to die prematurely. The disruption of the erythropoiesis translates into the reduction of mature erythrocytes in the circulation (Huether & McCance, 2015; Sun et al., 2015). This mechanism of cellular loss causes anemia.
Bizzaro, N., & Antico, A. (2014). Diagnosis and classification of pernicious anemia. Autoimmunity Reviews, 24(1), 1-4. Web.
Chan, C., Low, L., & Lee, K. (2016). Oral vitamin B12 replacement for the treatment of pernicious anemia. Frontiers in Medicine, 3(8), 4-16. Web.
Hooper, M., Hudson, P., Porter, F., & McCaddon, A. (2014). Patient journeys: Diagnosis and treatment of pernicious anemia. British Journal of Nursing, 23(4), 16-21. Web.
Huether, S., & McCance, K. (2015). Understanding pathophysiology. Berlin, Germany: Elsevier Health Sciences. Web.
Sun, A., Chang, J., Wang, Y., Cheng, S., Chen, H., & Chiang, C. (2015). Do all the patients with vitamin B12 deficiency have pernicious anemia? Oral Pathology & Medicine, 45(1), 23-27. Web.