Deb Smith, age fifty-six, came to her nurse practitioner (NP) with fatigue, pallor, dyspnea on exertion, and palpitations.

Deb Smith, age fifty-six, came to her nurse practitioner (NP) with fatigue, pallor, dyspnea on exertion, and palpitations. Her laboratory report indicates that her hematocrit, hemoglobin, and reticulocyte counts are low; that her MCV is high; and that her MCH and MCHC are normal. Her diagnosis is pernicious anemia.