Pernicious Anemia and Gaseous Gangrene

Pernicious Anemia 

There are different types of anemia based on the size of the red blood cell. The three include microcytic, normocytic, and macrocytic . In Macrocytic anemia, the red blood cells are large. This type is further subdivided into two categories, namely megaloblastic and non-megaloblastic anemia (Yeruva et al., 2016) . Megaloblastic anemia results from a deficiency in vitamin B12 or inadequate folate serum levels. Deficiencies in Vitamin B12 and folic acid result in the altered synthesis of DNA in the red blood cells (RBCs) (Chhabra et al. , 2015) . The alteration is achieved through interruption of the plasma membrane permeability hence allowing phosphatidylserine (PS) to leak. The resultant attack on RBCs reduces their level in the blood. The leading cause of pernicious anemia is active antibodies. Generally, pernicious anemia has an extended onset that eventually presents with fatigue, reduced appetite, body weakness, and numbness sensation in the limbs. 

Response 

My peer outlined the different types of anemia based on the size of the red blood cell. He has exemplarily elaborated on the three types, which includes; microcytic, normocytic and macrocytic. The different subdivision of macrocytic anemia has been stated with its associated causative factor. The paper also incorporated all the required details, such as the intensive review of the hallmark cause of the pernicious anemia. The various symptoms associated with pernicious anemia have also been captured. However, the treatment of pernicious anemia was not comprehensively captured. In pernicious anemia, the patient experiences an inability to absorb enough vitamin B-12 required for the development of adequate healthy red blood cells. Following confirmation by laboratory procedures such as screening for parietal antibodies, pernicious anemia can be treated through parenteral injections of vitamin B12. 

Clinical Situation 

A patient presents with low levels of serum vitamin B12 and elevated serum folate levels. With a microscopic view, it is noted that the patient’s blood has a characteristic leukopenia with hyper segmented granulocytes. Such a patient is likely to be suffering from pernicious anemia. 

Discussion Two 

Gaseous Gangrene 

This condition is also called myonecrosis or clostridial myonecrosis. It is a condition that presents with the death of the body's soft tissues. It is caused by a bacterium called Clostridium perfringens that produces tissue gas in gangrene. Gas gangrene infection emerges when the clostridial organisms produce theta and alpha toxins that damage the surrounding soft tissues. Owing to the facultative state of the clostridium perfringens, they spread very fast to the unoxygenated tissues (Amjad et al. , 2019) . Clostridium perfringens excrete varied exotoxins. Alpha toxins, also called the lecithinase, are applied when breaking down the cell membranes hence initiating platelet aggregation, thrombosis, and histamine production. Theta toxins such as hyaluronidase and hemagglutinins initiate injury to the blood vessels and breakdown of leucocytes. This causes inflammatory responses. Connective tissues are then broken down by collagenase, facilitating a faster spread of the organism across tissue planes. 

Treatment of gaseous gangrene is focused on preventing further spread of the infection. It is vital to curtail the condition’s spread using antibiotics. Surgical procedure and fluid resuscitation may also be done to recover the infected tissues. Patients should be monitored regularly and where necessary, given hyperbaric oxygen therapy (Riefler et al., 2015) . 

Response 

My peer explored this topic comprehensively. Firstly, he started by capturing the definition of the gaseous gangrene before proceeding to pathophysiology and later treatment. Pathophysiology was detailed and presented well with all the necessary information being captured. Likewise, treatment was highlighted, and possible therapies formulated. However, the clinical manifestation of the condition was not covered in the presentation. Lastly, the presentation did not include demographical data and prevalence of the disease. 

Clinical situation 

A patient was rushed to an emergency department suffering from a coma and had yellow skin coloration. The patient was further assessed, and the investigational results depicted kidney failure, widespread infections, and tissue death. This clinical situation describes a patient with gaseous gangrene. 

References 

Amjad, W., Chung, S., Mumtaz, M., Farooq, A., & Gondal, N. (2019). Gaseous liver abscess with Clostridium perfringens sepsis in a patient with neutropaenia.  Przegla̜d Gastroenterologiczny ,  14 (2), 160. doi : 1 0.5114/ pg .2019.85902

Chhabra, N., Lee, S., & Sakalis, E. G. (2015). Cobalamin deficiency causing severe hemolytic anemia: a pernicious presentation.  The American journal of medicine ,  128 (10), e5-e6. 

Riefler, J., Kosov, M., & Belotserkovskiy, M. (2015). The treatment of a gangrenous leg. Clinical Infectious Diseases, 61(6), 1032-1033. doi: 10.1093/cid/civ494 

Yeruva, S. L. H., Manchandani, R. P., & Oneal, P. (2016). Pernicious anemia with autoimmune hemolytic anemia: a case report and literature review.  Case reports in hematology , 1-4. doi: 10.1155/2016/7231503