In clinical settings, advanced practice nurses often encounter patients

with blood disorders such as anemia. Consider the case of a 17-year-

old girl who is rushed to the emergency room after suddenly fainting.
The girl’s mother reports that her daughter has had difficulty
concentrating for the past week, frequently becomes dizzy, and has
not been eating normally due to digestion problems. The mother also
informs the nurse that their family has a history of anemia. With the
family history of anemia, it appears that this is the likely diagnosis.
However, in order to properly diagnose and treat the patient, not only
must her symptoms and family history be considered, but also factors
such as gender, ethnicity, age, and behavior. This poses the question:
How do patient factors impact the incidence and prevalence of
different types of anemia?
To Prepare
· Review Chapter 21 in the Huether and McCance text. Reflect on the
pathophysiological mechanisms of iron deficiency anemia.
· Select one of the following types of anemia: pernicious anemia, folate
deficiency anemia, sideroblastic anemia, chronic inflammation
anemia, or post-hemorrhagic anemia. Identify the pathophysiological
mechanisms of the anemia you selected.
· Consider the similarities and differences between iron deficiency
anemia and the type of anemia you selected.
· Reflect on how patient factors such as genetics, gender, ethnicity,
age, and behavior might impact these anemic disorders.
Write
· An explanation of the pathophysiological mechanisms of iron
deficiency anemia
Iron deficiency anemia may be classified into 3 stages: storage iron deficiency, iron deficient
erythropoiesis, and iron deficiency anemia (1,2). Initially during blood loss, iron body stores are
preferentially utilized for accelerated erythropoiesis. After depletion of body iron stores,
erythropoiesis and production of other iron-containing proteins (such as myoglobin) become
limited, leading to an overt iron deficiency anemia (1,2). Anemia is exacerbated as iron-deficient
erythrocytes have a shortened survival due to their fragility, which accelerates reticuloendothelial
cell sequestration and destruction.
and the anemia you selected (pernicious anemia). explanation at the
cellular or molecular level (whenever possible).
In pernicious anemia vitamin B12 is unavailable owing to a lack of intrinsic factor, a substance
responsible for intestinal absorption of the vitamin. In a healthy person, intrinsic factor is produced by
the parietal cells of the stomach, the cells that also secrete hydrochloric acid. Intrinsic factor forms a
complex with dietary vitamin B12 in the stomach. The complex remains intact, preventing degradation
of the vitamin by intestinal juices, until it reaches the ileum of the small intestine, where the vitamin is
released and absorbed into the body. When intrinsic factor is prevented from binding with vitamin B12
or when the parietal cells are unable to produce intrinsic factor, the vitamin is not absorbed and
pernicious anemia results. This effect is thought to stem from an autoimmune reaction in which the
malfunctioning immune system produces antibodies against intrinsic factor and against the parietal
cells.

· Compare these two types of anemia, as well as their potential

causes.

The most common form of anaemia is iron deficiency anaemia which is usually due to chronic blood
loss caused by excessive menstruation. Iron deficiency occurs when the rate of loss or use of iron is
more than its rate of absorption and use. The reasons for this are

 Chronic blood loss: Most commonly due to excessive menstruation or bleeding into or from the
gut as a result of a peptic ulcer, gastritis, haemorrhoids or in children, worm infestation.

 Increased use of iron: In pregnancy, due to the growth of the foetus or children undergoing rapid
growth spurts in infancy and adolescence.

 Decreased absorption of iron

o after a partial or total removal of the stomach;

o lack of stomach acid;

o chronic diarrhoea; or

o malabsorption.

Pernicious anaemia is a condition in which the body can't make enough healthy red blood cells
because it doesn't have enough vitamin B12 (a nutrient found in certain foods). People who have
pernicious anaemia can't absorb enough vitamin B12 due to a lack of intrinsic factor (a protein made
in the stomach). However, other conditions and factors can also cause vitamin B12 deficiency.

Causes
 A lack of intrinsic factor is a common cause of pernicious anaemia as the body can't absorb
enough vitamin B12.
 Some pernicious anaemia occurs because the body's small intestine can't properly absorb
vitamin B12 which may be due to the wrong bacteria in the small intestines; certain diseases that
interfere with vitamin B12 absorption; certain medicines; surgical removal of part of the small
intestine; and tapeworm infection.
 Sometimes people develop pernicious anaemia because they don't get enough vitamin B12 in
their diets.

· Finally, explain how genetics, gender, ethnicity, age, and behavior

might impact the anemic disorders you selected.

Risk
Infants and young children, women, and adults who have internal bleeding are at highest risk for
iron-deficiency anaemia.

Risk
You are at higher risk for pernicious anaemia if you

 Have a family history of the condition.

 Have had part or all of your stomach removed.
 Have certain autoimmune disorders that involve the endocrine glands, such as Addison's
disease, type 1 diabetes, Graves' disease, and vitiligo.
 Have had part or all of your small intestine removed.
 Have certain intestinal diseases or disorders that prevent your body from properly absorbing
vitamin B12.
 Take medicines that prevent your body from properly absorbing vitamin B12.
 Are a strict vegetarian who doesn't eat any animal or diary products and doesn’t take a vitamin
B12 supplement, or if you eat poorly overall.