Pernicious Anemia

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Pernicious Anemia by Mind Map: Pernicious Anemia

1. Causes

1.1. Weakened stomach lining

1.1.1. Aging

1.2. Autoimmune disease

1.2.1. Crohn's disease

1.2.2. HIV

1.2.3. Celiac disease

1.2.4. Type 1 Disease

1.3. Hereditary

1.3.1. Common in Northern European and Scandinavian descent

1.4. Post gastric bypass surgery

1.5. Removal of ileum from small intestine

1.6. Antibiotic treatment removing normal flora from small intestine

1.6.1. Causes malabsorption.

1.7. Tapeworm infection

1.8. Diet low in B-12

1.8.1. Vegetarians and Vegans

2. Pathophysiology

2.1. Megaloblastic anemia

2.1.1. Most commonly associated with end-stage type A chronic autoimmune gastritis

2.2. Pernicious anemia is caused by a lack of intrinsic factor necessary for absorption of vitamin B12

2.2.1. B-12 is needed for red blood cell production.

2.3. Intrinsic factor is a protein that is produced by the stomach's parietal cells.

2.3.1. Parietal cells are attacked in cases of autoimmune disease, which causes a lack of intrinsic factor production.

2.4. Once a fatal condition, pernicious means "destructive" or "injurious."

2.5. Slow onset, most diagnoses around 60 years old.

3. Symptoms

3.1. Weakness

3.2. Fatigue

3.3. Nausea/Vomiting

3.4. Headache

3.5. Weight loss

3.6. Long-term complications

3.6.1. Gastric cancer

3.6.2. Other GI problems

3.6.3. Cardiovascular conditions

3.6.4. Peripheral nerve and neurological complications

3.7. Thick, red, smooth tongue.

4. Treatment

4.1. Vitamin B-12 injections

4.1.1. Daily or weekly depending on severity

4.1.2. Intramuscular

4.2. Oral B-12 supplement

4.3. Increase of B-12 in diet

4.3.1. Meat products

4.3.2. Dairy

4.3.3. Fortified foods (cereal)

4.4. Frequent B-12 monitoring

5. References

5.1. Hughes, J., Muegge, B., Tobin, G. S., Litvin, M., Sun, L., Saenz, J., & McGill, J. B., (2017). High-risk gastric pathology and prevalent autoimmune diseases in patients with pernicious anemia. Endocrine Practice, 23(11), 1297-1303. doi:http://dx.doi.org/10.4158/EP-2017-0056

5.2. McCance, K. L. &cRote, R. S. (2018). Alterations of the Erythrocyte, Platelet, and Hemostatic Function. In N. S. Rote & S. E. Huether (Eds.), Pathophysiology: The biologic basis for disease in adults and children (8th ed., pp. 932–933). Mosby.

5.3. Zhou, P., Hong, H., Yan, Z., Zheng, L., & Liu, X. (2018). Diagnostic value of oral “beefy red” patch in vitamin B12 deficiency. Therapeutics and Clinical Risk Management, 14, 1391-1397. doi:http://dx.doi.org/10.2147/TCRM.S159889

6. Diagnosis

6.1. CBC

6.1.1. Hemoglobin/Hematocrit

6.1.2. MCV

6.1.3. RBC, WBC, platelets

6.2. Vitamin B-12 level

6.3. Parietal cell antibodies and intrinsic factor antibodies

6.4. Reticulocyte level

6.4.1. Young red blood cells, those with pernicious anemia will have low levels.

6.5. Bone marrow tests

6.6. Diagnostic criteria

6.6.1. Megaloblastic anemia (moderate to severe)

6.6.2. Leukopenia

6.6.3. Low Vitamin B12

6.6.4. High levels of methylmalonic acid and homocysteine

6.6.5. Increase in hematocrit 5 days after paraenteral vitamin B12.