Nov 8, 2017 in Opinion

Physical Ttraits

Patients with pernicious anaemia normally exhibit clear complexion with a yellow tinge. Tongue and mucous membranes may become noticeably pale with the latter oftentimes being red and beefy while liver and spleen are enlarged. Numerous bleeding areas may appear on the skin with spots displaying a lack of pigmentation. When the cases of pernicious anaemia consist of a more significant involvement on part of the central nervous system, they could also include staggering gait among the other visible impairments (Eppinger 783).

Although such physical traits could be used for diagnosis of pernicious anaemia, the procedure is considerably more complex and involves multiple microscopic tests. Performed by a phlebotomist, most often through venipuncture, complete blood count (CBC) is one of those tests, used to determine the levels of haemoglobin, the protein that carries oxygen, and hematocrit, the volume of blood occupied by red blood cells. A small amount of the two is usually sign of anaemia. Complete blood count checks the number of other blood cells as well. Abnormal amounts of platelets and white blood cells could also lead to the diagnosis of anaemia. However it is important to notice that small values of those variables could also signify infection or some other sort of blood disorder. Another aspect of the tests is the mean corpuscular volume (MCV). It is a measure of the average size of red blood cells and considered to be an indicator because in pernicious anaemia, the erythrocytes are larger than those in a normal condition. Despite its momentous importance, the complete blood count test is only sufficient to discover the presence of anaemia. Further investigations are necessary to understand the type of anaemia.  One of them is the reticulocyte count test which measures the rate at which red blood cells are being produced by the bone marrow. It performs the task by estimating the number of young blood cells in the blood which when is low, suggests the state of pernicious anaemia. Since vitamin B12 is in a direct relation to pernicious anaemia, measuring its levels (the Schilling test) is another proper way of testing. The same statement applies to the amounts of homocysteine and methylmalonic acid (MMA) as well as to the presence of intrinsic factor antibodies and parietal cell antibodies. Finally but certainly not of least importance is the bone marrow test. It is done either through the process of aspiration or by biopsy. The former describes the manipulation when a doctor extracts a small amount of bone marrow liquid with a needle while the latter represents the procedure when bone marrow tissue is obtained using a larger needle and its cells, those that eventually turn into blood cells, subsequently examined. In pernicious anaemia, they are larger than normal and accordingly called macrocystic.

The progress of technology has made it possible for some of the tests to be immediately available to the patient regardless of his location.  This technique is called point of care diagnostics. Portable cartridges for instance allow to measure haemoglobin levels and hence to test for anaemia in pregnant women. The main advantage of using those mobile analyzers is to provide an almost constant monitoring of the patient’s clinical status without wasting time in the execution of complicated laboratory methods.

There is no absolute cure of the pernicious anaemia. Vitamin repletion eliminates symptoms of the illness but does not solve the problem decisively. There are two ways of vitamin intake, oral and through injection. While the first one is a cheaper and easier method based on dietary supplementation, it is oftentimes inefficient. The standard nursing procedure is subcutaneous or intramuscular injection on behalf of B12 replacement. The therapy is targeted at mitigating the acute phases of the illness and involves the gradual injection of vitamin into the bloodstream. In a usual treatment the figures are about 1000 units IM daily per week followed by the same weekly amount per month and finally monthly for life. Hence the procedure is a continuous ongoing process. The patient’s levels of blood cells will return back to normal for about a week, setting the point from which point of care diagnostics techniques should be used constantly to monitor blood condition. First the patient is informed with the possible complications of the procedure such as feelings of burn at the point of injection or diarrhoea and then the manipulation takes place (Hawley 52).

Since a patient suffering from pernicious anaemia can never be thoroughly cured, it is strongly recommended that he follows strictly the prescriptions for lifelong injections and dietary supplementation. The patient must report any changes in his health like the appearance of infections or other forms of physical deterioration because events of this kind would affect significantly the dosage of B12 and if left unreported may divert the course of treatment. Moreover those who suffer from pernicious anaemia are strongly encouraged to give themselves enough rest and to avoid engagement in cumbersome activities at least until blood condition has returned to its normal state (Hawley 52). Once this is achieved, a periodic adequate monitoring through the use portable devices allowing the conduction of complete blood count tests should become integral part of the patient’s programme. Although pernicious anaemia does not have a cure in the true meaning of the word, appropriate medical procedures combined with great self care and responsibility on the patient’s side can be sufficient to ensure a wholesome life without suffering. 

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