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Teri’s Pernicious Anemia

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PHYS 261: Human Physiology

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Abstract

The present case given is due to Teri, she was diagnosed with pernicious anemia. She visited her

primary care provider due to experiencing a seizure this week and feeling depressed for a few

months. As a result of her condition, she was ordered a multitude of tests by her physician. The

evaluations returned as low hematocrit, vitamin B12 deficiency, low oxygen levels,

autoantibodies of the parietal cell, and abnormal red blood count. Given the values above and her

diagnosis, her autoantibodies are destroying her parietal cells found in the stomach, specifically

in the glands.
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Introduction

Digestive System

The digestive system is a process that mechanically and chemically breaks down food

into nutrients for absorption in the small intestines into the bloodstream. Digestion occurs in

three phases, cephalic phase (head), gastric phase (stomach), and intestinal phase (intestines).

Secretory epithelial cells and accessory digestive organs that include the liver, pancreas,

gallbladder, and salivary glands assist in food conversion. Chyme is semi-digested food with

gastric juices located in the stomach before entering the small intestine. The food contains three

macronutrients that must be digested before absorption, (1) trypsin- proteins, (2) amylase-

carbohydrates, (3) lipase- fats. Once these macromolecules are converted into monomers, they

are then able to be absorbed in the duodenum into the bloodstream. Food moves through the

gastrointestinal (GI) tract by peristalsis in the upper GI and segmentation in the lower GI. Within

the intestinal epithelium, the remainder of the products is absorbed and enters the interstitial

fluid. Then it is secreted into the bloodstream or the lymphoid for distribution. In the large

intestine, the remainder of the water is absorbed, vitamin k and biotin are produced via bacteria.

Feces is then produced to exit through the anus.

Cardiovascular System

The cardiovascular system's primary purpose is to supply blood throughout the body by

propelling continuously. The response to several stimuli can control the blood volume and

velocity flowing through the vessels. The heart, veins, arteries, and capillaries are all parts of the

cardiovascular system. It allows deoxygenated blood to be oxygenated in the lungs and remove

cellular waste. Cell-to-cell communication is also a key role in defending the body from foreign

invaders. The complex system of the heart and vessels working together allowing adequate blood
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flow to their target sites. The regulation of the cardiovascular system occurs by a multitude of

stimuli by alteration of BV, electrolytes, hormones, adrenal glands, kidneys, etc. The sympathetic

and parasympathetic systems also contribute to the regulation of the cardiovascular system

(Chaudhry et al., 2020).

Immune System

The immune system is the body’s ability to fight against foreign invaders and be the first

line of defense. It protects the body against bacteria, pathogens, parasites, viruses, etc. The

immunes system's innate response occurs naturally and is the first one to defend. These include

sweat, saliva, skin tears, and numerous cells such as basophils, eosinophils, NK cells, epithelial

cells, etc. It will also cause inflammation to the target sites. Also, phagocytosis will occur. The

immunes system adaptive response will access specific lymphocytes, immunoglobulins, and

cytokines to attacks invading microbes as another response. It is triggered by a particular antigen,

immunogen, or pathogen. The immune response can fight against millions of intruders and then

create memory cells to generate a faster repose (Justiz et al., 2020).

Teri’s Case

Secretory Cells:

The parietal cell is a part of the gastric gland and gastric mucosa. Since Teri’s parietal cell

was destroyed, substances that she is now lacking are the intrinsic factor and gastric acid also

known as hydrochloric acid (HCl). The function of HCl is to convert an inactive enzyme

pepsinogen into an active form of pepsin. Due to the lack of HCl Teri will not be able to convert

pepsinogen into pepsin and will not be able to kill bacteria. The intrinsic factor is utilized to

absorb vitamin B12. If the intrinsic factor is not present, then Teri will be deficient in vitamin

B12 and lack DNA synthesis (Silverthorn et al., 2019, pp. 671-672).

Intrinsic Factor:

Gastric parietal cells secrete a protein known as intrinsic factor. Vitamin B12 binds to the

intrinsic factor within the lumen of the stomach and is needed for absorption to occur in the

intestines. Due to the destruction of the parietal cells, there will be a lack or absence of the

intrinsic factor causing vitamin B12 deficiency, which is known as a condition named pernicious

anemia. Therefore, erythropoiesis will be gravely decreased, but Teri can be given supplemental

vitamin B12 shots to remediate her condition (Silverthorn et al., 2019, p. 683).

Chief Cells:

The chief cells of the gastric glands secrete a protein called pepsinogen. It is considered

an inactive enzyme and is converted into the active form of pepsin by the innervation of HCl

within the parietal cells. Pepsin’s function is to breakdown proteins and kills bacteria. Teri’s

pernicious anemia produces antibodies against the parietal cells. Therefore, it inhibits the
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production secreted by the parietal cells and is unable to convert pepsinogen into pepsin (Mehta,

2017).

Erythrocytes:

In a normal state, Teri’s mature RBCs would be shaped in a biconcave disc form and

its lifespan would be up to 120 days. The formation of RBCs is within the bone marrow

known as erythropoiesis controlled by the release of erythropoietin. Mature RBCs do not

contain a nucleus or mitochondria. RBCs contain a protein called hemoglobin which carries

oxygen throughout the body (Mehta, 2018).

Blood Volume:

Hematocrit is the total blood volume percentage that is located within the RBCs by

centrifugation. The normal value for a male is 45-54% and for a female, it is 37-47%. A blood

draw sample must be taken in a narrow capillary tube for a centrifuge to be conducted, for the

plasma and formed elements to be separated. Erythrocytes with be the densest, leukocytes and

thrombocytes will be a thin layer above the erythrocytes, and lastly, the plasma will sit on top,

which in turn will give the red cell count (Silverthorn et al., 2019, p. 517).

Erythropoietin:

For the body to maintain homeostasis we use a negative feedback loop. Since Teri has

hypoxia the hormone erythropoietin (EPO) will be released where it is primarily produced in the

kidney and liver to innervate erythropoiesis. When hypoxia is detected by chemoreceptors the

kidney and liver are stimulated to release erythropoietin into the bloodstream. Erythropoietin

then stimulates the red bone marrow to produce more RBCs and therefore increase oxygen (O2)

carrying capacity and increases O2 levels returning to homeostasis (Silverthorn et al., 2019).
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Oxygen Transporter:

Hemoglobin is the protein that transports O2 in our body. When hemoglobin (Hgb) is

bound to O2 it is labeled as Oxy-Hgb and when there is no O2 bound to Hgb it is labeled as

deoxy-Hgb.

Hgb Structure

The structure of an Hgb is 4 chains: 2 alpha chains and 2 beta chains. Each chain contains a

protein called heme. The heme contains iron the site where it binds to O2. The Hgb can transport

four O2 molecules at a time (Mehta, 2018).

B Cells:

B cells are also known as B lymphocytes secrete antibodies and have multiple functions.

Immunoglobulins are present on the surface of B cells utilized as antigen receptors. B cells are

formed and mature in the bone marrow. The immune branch that they are a part of is the humoral

immunity found in extracellular fluid and secrete antibodies. Before the B cells can produce or

release antibodies it must convert into a plasma cell containing no receptors (Mehta, 2017).

Functions of Antibodies

 Antibodies allow an antigen to bond it activates the B cell.

 Antibodies behave as an opsonin to advertise antigens for phagocytosis.

 Antibodies will come together enabling the antigens to clump and neutralize

toxins.

 Antibodies will trigger dependent cellular activity such as natural killer (NK) cells

or eosinophils.
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 Antibodies will activate complement proteins due to antibody binding.

 Antibody and antigen will bind to a mast cell causing it to degranulate.

Gamma Globulins:

IgG: Monomer

 Most common type

 Designates previous infections

IgA: Dimer

 Located in mucous membranes and secretions such as saliva, tears, sweat GI tract,

breast milk, etc.

 Smallest antibody

IgM: Pentamer

 The largest antibody found in the body

 First to be produced

IgE: Monomer

 In charge of type 1 hypersensitivity and allergic reactions

 Binds to basophils and mast cells to generate degranulation

IgD: Monomer

 B cell receptor

 Triggers basophils and mast cells

Antibody Structure:
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An immunoglobins structure is made up of two identical light chains and two identical

heavy chains. They are both linked by disulfide bonds. It is shaped in a Y form. The Fab region

contains one heavy chain and one light chain with an antigen-binding site. The FC region located

at the bottom of the heavy chains is the WBC binding site. The constant region is a major part of

the lower antibody where it will remain the same. The upper part of the antibody that changes is

called the variable region (Silverthorn et al., 2019).

Conclusion

In conclusion, Teri’s pernicious anemia has compromised her state of homeostasis and

has caused other symptomologies such as depression and a seizure due to vitamin B12

deficiency. Teri lacks the ability to produce intrinsic factor due to the autoimmunity of her

parietal cells. The lack of vitamin B12 has compromised red blood cell production and bodily

function. Her small intestine will not absorb vitamin B12 and other nutrients from her diet. Also,

her lack of pepsin will not allow her to properly break down proteins and kill bacteria. Teri will

have to seek treatment to treat her vitamin B12 deficiency.

References

Chaudhry R, Miao JH, Rehman A. Physiology, Cardiovascular. [Updated 2020 Nov 20]. In:

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available

from: https://www.ncbi.nlm.nih.gov/books/NBK493197/

Justiz Vaillant AA, Sabir S, Jan A. Physiology, Immune Response. [Updated 2020 Sep 27]. In:

StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available

from: https://www.ncbi.nlm.nih.gov/books/NBK539801/

Mehta, S. (2017, December 27). Digestive System. YouTube. https://www.youtube.com/watch?

v=SbJnP5HFo9g&feature=youtu.be

Mehta, S. (2018, February 16). Blood. YouTube. https://www.youtube.com/watch?

time_continue=290&v=pM-JlMDqIgA&feature=emb_logo

Mehta, S. (2017, December 27). Immune System. YouTube. https://www.youtube.com/watch?

v=giuuBW0Eyw4&feature=youtu.be

Patricia JJ, Dhamoon AS. Physiology, Digestion. [Updated 2020 Sep 18]. In: StatPearls

[Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from:

https://www.ncbi.nlm.nih.gov/books/NBK544242/

Silverthorn, A. C., Johnson, B. R., Ober, C. E., & Impagliazzo, A. (2019). Human Physiology

(8th ed.). Pearson Education, Incorporated.