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

Discussion #1


1. What are the laboratory tests to be ordered in patients suspected of anemia? When anemia is suspected in a patient a Complete Blood Count with differential (CBC w/diff) is ordered by the health care provider. the first test used to diagnose anemia is a complete blood count (CBC). The complete blood count measures different blood levels such as, the number of red blood cells, white blood cells, and platelets in your blood. Included in this battery of blood work is the hemoglobin, the iron-rich protein in red blood cells that carries oxygen to the body. Then the hematocrit, is a measure of how much space red blood cells take up in your blood. A low level of hemoglobin or hematocrit is a sign of anemia. These levels can give the clinician a care direction to proceed in as it relates to anemia. When CBC results are suggestive of anemia, the practitioner may order hemoglobin electrophoresis, a test that measures multiple types of hemoglobin in the blood and helps to diagnose which anemia the patient may have. Depending on the findings other tests may be ordered including, a reticulocyte count, serum iron and ferritin tests, transferrin level and total iron binding capacity tests may be ordered as well (Nagalla, 2017) 2. What are the clinical manifestations noted in a patient with pernicious anemia? The clinical manifestations of pernicious anemia include pallor, tachycardia, weakness, fatigue, and palpitations. Common neurologic manifestations include paresthesia, weakness, gait abnormalities, and cognitive or behavioral changes. Pernicious anemia progresses at a slow pace. Therefore, symptoms may not manifest until patients are advanced in age or are leading very busy lifestyles with little to no rest. Pernicious Anemia is an autoimmune disease; autoimmune diseases are characterized by the body attempting to destroy itself. In the case of pernicious anemia, the body produces an antibody that attacks the protein responsible for extracting vitamin B12 from food sources (Nagalla, 2017). 3. What are nonpharmacological therapies associated with the treatment of pernicious anemia? Vitamin B12 is available for therapeutic use parenteral as either cyanocobalamin or hydroxocobalamin. [The two forms are equally useful in the treatment of vitamin B12 deficiency, and both are nontoxic. Theoretical advantages exist to using hydroxocobalamin because it is retained better in the body and is more available to cells; however, both chemical forms of cobalamin provide prompt correction(Nagalla, 2017, para. 4) 4. What the lab findings indicative iron deficiency anemia? In patients with anemia the red blood cells are smaller and paler than usual. Normal hematocrit levels are generally between 34.9 and 44.5 percent for adult women and 38.8 to 50 percent for adult men. These values may change depending on your age. Hemoglobin lower than normal hemoglobin levels indicate anemia. The normal hemoglobin range is generally defined as 13.5 to 17.5 grams (g) of hemoglobin per deciliter (dL) of blood for men and 12.0 to 15.5 g/dL for women (“Anemia,” 2019). Generally, men have higher levels of serum iron than women. Although laboratory ranges vary, most provide male ranges of around 65 to 176 µg/dL and female ranges of 50 to 170 µg/dL. When laboratories test for SI, they are testing iron contained in plasma that is generally bound to transferrin. Normal ferritin levels range from 12 to 300 nanograms per milliliter of blood (ng/mL) for males and 12 to 150 ng/mL for females.(“Anemia,” 2019) 5. Please share possible complications of untreated pernicious anemia. If untreated, the neurological complications of pernicious anemia can be permanent and end in death, but the administration of vitamin B-12 efficiently and effectively treat pernicious anemia. Life-long treatment is required. Pernicious anemia can cause life threatening complications if left untreated including, vascular disease such as, stroke, myocardial infarction, pulmonary embolism, and deep vein thrombosis because this deficiency causes hyperhomocysteinemia. B12 is the cofactor for the conversion of homocysteine into methionine. Excess homocysteine causes blood vessels to lose their elasticity, making it harder for them to dilate and damaging their inner lining. That damage, in turn, allows cholesterol, collagen, and calcium to build up, causing plaque formation. The short- and long-term ramifications are enormous. Untreated B12 deficiency causes balance problems, paresthesia, weakness, dizziness, postural hypotension, and visual disturbances. These symptoms dramatically increase the risk of falls, which, in turn, lead to trauma, hospital stays, loss of loss of independence, nursing home placement, and premature death (“Anemia,” 2019) 6. What is the purpose of the Schilling test? The purpose of the Schilling test is to show how well the body absorbs vitamin B12 usually. This test can be completed in four stages to identify the cause of low vitamin B12 levels. Stage one requires the patient to receive two doses of vitamin B12 (cobalamin) along with a small, first dose of a radioactive form of B12 by mouth. Then the patient will receive a second, larger dose by a shot 1 hour later. After the shot, the patient will need to collect their urine over the next 24 hours and deliver it to a lab or their doctor’s office.  If stage one is abnormal, stage two may be done three to seven days later. In stage two the patient is given radioactive B12 along with intrinsic factor. Intrinsic factor is a protein produced by cells in the stomach lining. The body needs it so the intestines can absorb vitamin B12 efficiently. Stage II of the test can tell whether low vitamin B12 levels are caused by problems in the stomach that prevent it from producing intrinsic factor. If the stage II test is abnormal, a stage three test is performed. Stage three test is done after the patient has taken antibiotics for two weeks. It can tell whether abnormal bacterial growth has caused the low vitamin B12 levels. Stage four test determines whether problems with the pancreas cause low vitamin B12 levels. With this test, the patient will take pancreatic enzymes for three days, followed by a radioactive dose of vitamin B12 top of form (Underwood, 2016).





Discussion #2


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


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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