Chapter 6, Problem 151R

Mr. Johnson, 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 Discuss the treatment available and the limitations.

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

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

Mr. Johnson, 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 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.)

Thrombocytopenia (throm-bo-sye-tow-pee-ne-ah) is a disorder that develops when certain drugs, bone marrow cancer, or radiation destroys red bone marrow, including stem cells that give rise to platelets. Predict a likely symptom of this disorder.

_____________________ Plasmapheresis is the removal of whole blood from the body, separation of its cellular elements, and reinfusion of these cellular elements suspended in saline or a plasma substitute.