Question: mr x age 57 presented to his physician with marked...

Mr. X, age 57, presented to his physician with marked fatigue, nausea with occasional diarrhea, and a sore, swollen tongue. Lately he also has been experiencing a tingling feeling in his toes and a feeling of clumsiness. Microscopic examination of a blood sample indicated a reduced number of erythrocytes, many of which are megaloblasts, and a reduced number of leukocytes, including many large, hypersegmented cells. Hemoglobin and serum levels of vitamin B₁₂ were below normal. Additional tests confirm pernicious anemia.

1. Relate the pathophysiology of pernicious anemia to the manifestations listed above. (See Pernicious Anemia.)
2. Discuss how the gastric abnormalities contribute to vitamin B₁₂ and iron deficiency and how vitamin B₁₂ deficiency causes complications associated with pernicious anemia. (See Pernicious Anemia—Pathophysiology, Etiology.)
3. Discuss other tests that could be performed to diagnose this type of anemia. (See Pernicious Anemia—Diagnostic Tests.)
4. Discuss the treatment available and the limitations.
5. Classify pernicious anemia based on structural changes in erythrocytes, amount of hemoglobin and oxygen carrying capacity of RBC