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).