In October, your 52 yr old female patient comes in complaining of the following:

Question

In October, your 52 yr old female patient comes in complaining of the following:

General feeling of tiredness or weakness (fatigue)

Lack of energy Pale skin (pallor)

Dizziness

Headaches

She says that she has felt this way for about two months, but she has come to see you today because she has developed a feeling of cold or numbness in hands and/or feet, shortness of breath, and chest pain.

Upon examination, you discover that she also has a fast and irregular heartbeat.

You order a CBC and the results return indicating a normal Hb level, but a decreased number of RBCs.

1.What possible type(s) of anemia, if any, can be ruled out from the CBC results?

After a bit more conversation focused on any changes over the last year, you discover that your patient has lost 100 lbs following gastric reduction, and is living as a strict vegetarian. You order another blood test to examine the level of intrinsic factor.

2. What do you suggest she change about her diet? Why?

3. Your patient asks why you checking on her levels of Intrinsic Factor? She thought anemia was a RBC issue not a stomach issue. She asks if her weight loss surgery has caused her to bleed and lose RBCs. How do you answer her and explain what Intrinsic Factor does?

4. Your patient's level of Intrinsic Factor is very low; will she require life-long treatment? Why or Why not?

Explanation / Answer

1.The CBC report shows it is anemia but for knowing type more history and examination is needed. 2 As she is on vegan diet due to gastric reduction , so she was advised to take B12 vitamin supplements or meat products(as vitamin B12 is in highest concentration) 3.Intrinsic factor helps in absorption of vitamin B12, any deficiency of intrinsic factor leds to malabsorption of vitamin B12 which leds to pernicous anemia, anemia is not only about RBC but also other factors are also involved such intrinsic factor , depending upon the factor the anemia is of many types. 4.If intrinsic factor is low then by patient is advised to take supplements for few months not life long because by gastric reduction treatment will cause defeiceny for few month as the parital cells are damaged but after some time they cells will develop and then start release the intrinsic factor and on diet full of vitaminB12.  

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