1. What are the laboratory tests to be ordered in patients
suspected of anemia?

First, anemias are usually a result from impaired erythrocyte
production, blood loss,

increased erythrocyte destruction, or a combination of these three
factors (McCance &Heuther,

2014). Before laboratory tests are ordered, a patient will present
with changes in their condition.

Their skin, mucous membranes, lips, nail beds, and conjunctivae
become pale due to a lower

hemoglobin concentration (McCance &Heuther, 2014). There will
be various findings in the

different types of anemias, but typical laboratory tests include:
Hemoglobin, Hematocrit,

Reticulocyte count, Serum B12, Mean corpuscular volume (MCV),
Ferritin, Transferrin, Plasma

iron, Total iron-binding capacity (TIBC), Free erythrocyte
protoporphyrin, and Folate (McCance

&Heuther, 2014).

2. What are the clinical manifestations noted in a patient with
pernicious anemia?

Pernicious anemia is caused from a lack of intrinsic factor, which
is normally produced in

the stomach and enables absorption of vitamin B12 (McCance
&Heuther, 2014). To properly

diagnosis pernicious anemia (PA) there are many tests which
include: blood tests, bone marrow

aspiration, serologic studies, gastric biopsy, and clinical
manifestations (McCance &Heuther,

2014). PA is a slow developing disease and early symptoms are
nonspecific. Many times, a

patient presents with infections, mood swings, and
gastrointestinal, cardiac, or kidney ailments

(McCance &Heuther, 2014). Classic signs of anemia are:
weakness, fatigue,

paresthesia of the feet and fingers, difficulty in walking, loss
of appetite, abdominal pains and

weight loss. The patient’s skin may have a yellowish tint due to a
combination of pallor and

icterus (McCance &Heuther, 2014). Neurological problems may
occur as well. Neuronal death

and spinal cord problems such as: loss of position and vibration
sense, ataxia, and spasticity may

occur (McCance &Heuther, 2014).

3. What nonpharmacological therapies are associated with the
treatment of pernicious

anemia?

Pernicious anemia is usually treated with Vitamin B12 injections
or administering it

orally. The only other way to get this vitamin into a patient’s
system is orally through food. From

greatest to least clams, Liver, Fortified cereal, Trout, Salmon,
canned tuna, beef, nonfat plain

Greek yogurt, low-fat milk, ham, eggs, and chicken breast are all
great sources of Vitamin B12

(Harvard Health, 2016).

4. What the lab findings indicative iron deficiency anemia?

Iron-deficiency anemia is diagnosed by a variety of blood tests
and should always include

complete blood count (CBC) (Hematology.org, 2018). A patient is
considered anemic when their

Hemoglobin and Hematocrit (H/H) levels are below 7 to 8 g/dl.
Other tests such as serum

ferritin, iron, total iron-binding capacity, and transferrin are
typically ordered. A patient who is

anemic from iron deficiency, will usually have: Low H/H, Low mean
cellular volume (MCV),

Low ferritin, Low serum iron (FE), High total iron-binding
capacity (TIBC) and Low iron

saturation (Hematology.org, 2018).

5. Please share possible complications of untreated pernicious anemia.

If PA is left untreated it is fatal, usually because of heart
failure (McCance &Heuther,

2014). Death occurs usually after 1-3 years of recurring
remissions and exacerbations. 

Patients may suffer from neurological problems and it has been
noted that

there is an increased prevalence of serum vitamin B12 deficiency
among patients with Alzheimer

disease (McCance &Heuther, 2014). Another dangerous
complication is gastric cancer. Focusing on diet changes and routinely getting
Vitamin

B12 injections are vital if a patient’s lab values do not change.

6. What is the purpose of the Schilling test?

The Schilling test can help providers determine whether the
stomach is producing

intrinsic factor (IF) (Healthline, 2018). Because IF is essential
for vitamin B12 absorption, this

test analyzes the urine to determine the vitamin deficiency. The
Schilling test is an older test

that is not used in many laboratories these days. It indirectly
evaluated vitamin B12 absorption

by administering radioactive B12 and measuring excretion in the
urine (McCance &Heuther,

2014). If a patient had low urinary excretion of this indicated
PA.

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