Question

A client presents to the clinic exhibiting symptoms of pernicious anemia. Which diagnostic test would the nurse expect the physician to order that would most likely confirm the diagnosis? A. Urine analysis B. White blood cell count C. Prothrombin time test D. Schilling test

Short answer

Answer: The Schilling test (Option D) would be most likely to confirm the diagnosis of pernicious anemia, as it specifically assesses vitamin B12 absorption and the presence of intrinsic factor.

Step-by-step solution

Understanding Pernicious Anemia

Pernicious anemia is a type of vitamin B12 deficiency anemia, caused by impaired absorption of vitamin B12 due to a lack of intrinsic factor, which is a protein produced by the stomach. This leads to a decreased production of red blood cells and can cause various symptoms such as fatigue, weakness, and cognitive impairment.

Option A: Urine Analysis

Urine analysis is a test that examines the content of urine to assess various parameters like glucose levels, pH balance, and presence of crystals, blood, or bacteria. It is not a specific test for diagnosing pernicious anemia and would not provide conclusive evidence of this condition.

Option B: White Blood Cell Count

A white blood cell count, also known as leukocyte count, measures the number of white blood cells in the blood. While a high white blood cell count might indicate various infections or inflammation, it is not a specific marker for pernicious anemia and would not provide a definitive diagnosis.

Option C: Prothrombin Time Test

Prothrombin time test is a blood test that measures how long it takes for the blood to clot. This test is often used to evaluate the effectiveness of blood-thinning medications or to diagnose bleeding disorders. It is not specific to pernicious anemia and would not provide a definitive diagnosis.

Option D: Schilling Test

The Schilling test is a diagnostic test specifically designed to determine the cause of vitamin B12 deficiency. It involves the administration of radiolabeled vitamin B12 and then measuring its excretion in the urine. The presence of intrinsic factor is also assessed and supplemented if necessary during the test. This test can pinpoint the cause of B12 deficiency, helping to diagnose pernicious anemia.

Conclusion

Based on the analysis of all the options, the Schilling test (Option D) is the diagnostic test that would most likely confirm the diagnosis of pernicious anemia, as it specifically assesses vitamin B12 absorption and the presence of intrinsic factor.

Key concepts

Schilling Test

The Schilling test is a clinical procedure employed to determine the underlying cause of vitamin B12 deficiency, a common indicator of pernicious anemia. This test was once a standard but is now rarely used due to the development of more modern methods.

During the Schilling test, a patient is first given an oral dose of radioactive vitamin B12. The body's absorption of this vitamin is then monitored by measuring its subsequent excretion in the urine. If the vitamin B12 is not adequately absorbed, the test may be repeated with the addition of intrinsic factor. If absorption improves with intrinsic factor, it suggests that the patient's body does not produce enough intrinsic factor on its own, a condition associated with pernicious anemia.

To improve the value of the Schilling test, healthcare providers ensure accurate measurement techniques and may conduct the test in multiple stages to differentiate between various absorption issues and other similar conditions.

Vitamin B12 Deficiency

Vitamin B12 deficiency is a condition characterized by insufficient levels of vitamin B12, an essential nutrient vital for the production of red blood cells and the maintenance of the nervous system. Symptoms develop slowly over time and can include fatigue, weakness, constipation, loss of appetite, weight loss, numbness and tingling in the hands and feet, and problems with balance.

A diet lacking in B12, an inability to absorb B12 from food, or pernicious anemia, which inhibits the production of intrinsic factor, necessary for B12 absorption, can cause this deficiency. To mitigate vitamin B12 deficiency, sources like meat, dairy products, and fortified foods are recommended, alongside supplements if necessary. Diagnosis is typically made by blood tests measuring B12 levels, and treatment depends on the severity of the deficiency.

Intrinsic Factor

Intrinsic factor is a glycoprotein produced by the parietal cells of the stomach lining. It is essential for the absorption of vitamin B12 (cobalamin) in the small intestine. Vitamin B12 must bind with intrinsic factor before it can be absorbed; without this binding, B12 cannot be taken up by the body, leading to deficiency and possibly pernicious anemia.

Autoimmune conditions can lead to intrinsic factor deficiency, as the body produces antibodies that attack stomach cells or the intrinsic factor itself. Understanding intrinsic factor's role is critical for healthcare providers as it underlines the importance of the Schilling test – a test that can be used to determine intrinsic factor deficiency and help in the diagnosis of pernicious anemia.

Nursing Assessment

Nursing assessment for patients with suspected pernicious anemia involves a thorough evaluation to ensure accurate diagnosis and effective management. Nurses play a critical role in patient history collection, noting symptoms like fatigue, weakness, or cognitive disturbances, which could indicate B12 deficiency and thus relate to pernicious anemia.

During clinical examination, nurses look for signs such as pallor, jaundiced skin, and an enlarged liver or spleen. They will also assess neurological function, as vitamin B12 deficiency can lead to nervous system abnormalities. Patient dietary habits and family history are reviewed to determine risk factors. Nurses collaborate with physicians in evaluating results from diagnostic tests such as the Schilling test and advocate for the patient's understanding of their condition and adherence to the treatment plan.