Hematologic Disorders and Anemia Q 34

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The nurse understands that the client with pernicious anemia will have which of the following distinguishing laboratory findings?

  

     A. Schilling’s test elevated

     B. Intrinsic factor, absent

     C. Sedimentation rate, 16 mm/hour

     D. RBCs 5.0 million

    

    

Correct Answer: B. Intrinsic factor, absent.

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The defining characteristic of pernicious anemia, a megaloblastic anemia, is lack of the intrinsic factor, which results from atrophy of the stomach wall. Without the intrinsic factor, vitamin B12 cannot be absorbed in the small intestines, and folic acid needs vitamin B12 for DNA synthesis of RBCs. The gastric analysis was done to determine the primary cause of the anemia.

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Option A: An elevated excretion of the injected radioactive vitamin B12, which is a protocol for the first and second stage of the Schilling test, indicates that the client has the intrinsic factor and can absorb vitamin B12 into the intestinal tract. Patients presenting with signs and symptoms of cobalamin used to undergo this test. The most common features of vitamin-B12 deficiency include severe macrocytic anemia and variable neurologic abnormalities such as shuffling gait, with no improvement observed upon the administration of folic acid.

Option C: A sedimentation rate of 16 mm/hour is normal for both men and women and is a nonspecific test to detect the presence of inflammation. It is not specific to anemias. The erythrocyte sedimentation rate (ESR) is a common hematology test that measures how quickly red blood cells settle to the bottom of an elongated tube due to gravitational force. It is a nonspecific measure of inflammation due to various causes, including infection, autoimmune disorders, and cancers.

Option D: An RBC value of 5.0 million is a normal value for both men and women and does not indicate anemia. Whether or not a patient becomes symptomatic depends on the etiology of anemia, the acuity of onset, and the presence of other comorbidities, especially the presence of cardiovascular disease. Most patients experience some symptoms related to anemia when the hemoglobin drops below 7.0 g/dL.

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