Macrocytic anemia physical examination: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Macrocytic anemia}} | {{Macrocytic anemia}} | ||
{{CMG}}; {{AE}} {{ADS}} | {{CMG}} {{shyam}}; {{AE}} {{ADS}} {{OK}} | ||
==Overview== | ==Overview== | ||
Common physical examination findings of [[megaloblastic anemia]] include [[glossitis]], [[pallor]], [[mouth ulcers]], [[vitiligo]], [[Subacute combined degeneration of spinal cord|subacute combined degeneration]], and positive [[Romberg's test|Romberg's]] sign. | |||
==Physical Examination== | ==Physical Examination== | ||
Physical examination of | Physical examination includes the following: <ref name="pmid292640272">{{cite journal |vauthors=Nagao T, Hirokawa M |title=Diagnosis and treatment of macrocytic anemias in adults |journal=J Gen Fam Med |volume=18 |issue=5 |pages=200–204 |date=October 2017 |pmid=29264027 |pmc=5689413 |doi=10.1002/jgf2.31 |url=}}</ref><ref name="pmid6768440">{{cite journal |vauthors=Shojania AM |title=Problems in the diagnosis and investigation of megaloblastic anemia |journal=Can Med Assoc J |volume=122 |issue=9 |pages=999–1004 |date=May 1980 |pmid=6768440 |pmc=1801696 |doi= |url=}}</ref><ref name="pmid21704372">{{cite journal |vauthors=Rauw J, Wells RA, Chesney A, Reis M, Zhang L, Buckstein R |title=Validation of a scoring system to establish the probability of myelodysplastic syndrome in patients with unexplained cytopenias or macrocytosis |journal=Leuk. Res. |volume=35 |issue=10 |pages=1335–8 |date=October 2011 |pmid=21704372 |doi=10.1016/j.leukres.2011.05.001 |url=}}</ref> | ||
===Appearance of the Patient=== | ===Appearance of the Patient=== | ||
*Patients with megaloblastic anemia usually appear pale | *Patients with megaloblastic anemia usually appear pale and fatigued | ||
===Vital Signs=== | ===Vital Signs=== | ||
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* [[Pallor]] | * [[Pallor]] | ||
* [[Vitiligo]]- in autoimmune diseases related to pernicious anemia | * [[Vitiligo]]- in autoimmune diseases related to pernicious anemia | ||
* [[Jaundice]] | * [[Jaundice]] | ||
===HEENT=== | ===HEENT=== | ||
* Pale [[ | * Pale [[conjunctiva]] | ||
* [[Optic atrophy]] | * [[Optic atrophy]] on fundus exam | ||
* [[Icterus]] | * [[Icterus]] | ||
* [[Glossitis]] | |||
* [[Mouth ulcers]]<ref name="pmid24942828">{{cite journal |vauthors=Devalia V, Hamilton MS, Molloy AM |title=Guidelines for the diagnosis and treatment of cobalamin and folate disorders |journal=Br. J. Haematol. |volume=166 |issue=4 |pages=496–513 |date=August 2014 |pmid=24942828 |doi=10.1111/bjh.12959 |url=}}</ref> | |||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with megaloblastic anemia is usually normal. | * Neck examination of patients with [[megaloblastic anemia]] is usually normal but can sometimes show thyromegaly is hypothyroidism or hyperthyroidism are the causes of megaloblastic anemia. | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with megaloblastic anemia is usually normal. | * Pulmonary examination of patients with [[megaloblastic anemia]] is usually normal. | ||
===Heart=== | ===Heart=== | ||
*[[Heave]] / [[thrill]] | *[[Heave]] / [[thrill]] | ||
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===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with megaloblastic anemia is usually normal. | * Abdominal examination of patients with megaloblastic anemia is usually normal but can sometimes show hepatomegaly if liver disease is the cause of megaloblastic anemia. | ||
===Back=== | ===Back=== | ||
* Back examination of patients with megaloblastic anemia is usually normal. | * Back examination of patients with megaloblastic anemia is usually normal. | ||
| Line 67: | Line 46: | ||
* Genitourinary examination of patients with megaloblastic anemia is usually normal. | * Genitourinary examination of patients with megaloblastic anemia is usually normal. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* | *Patients are usually oriented to persons, place, and time. | ||
* | * [[Hyporeflexia]] or [[areflexia]] | ||
* Positive (abnormal) [[Babinski's Reflex|Babinski]] / [[plantar]] reflex | |||
* Positive (abnormal) Babinski / plantar reflex | *Unilateral/bilateral upper/lower extremity [[weakness]] | ||
*Unilateral/bilateral upper/lower extremity weakness | |||
**Can proceed to [[paraplegia]] | **Can proceed to [[paraplegia]] | ||
*Unilateral/bilateral sensory loss in the upper/lower extremity | *Unilateral/bilateral [[sensory loss]] in the upper/lower extremity | ||
**Position and vibration sense is impaired | **[[Positional nystagmus|Position]] and [[vibration]] sense is impaired | ||
*Abnormal gait | *Abnormal [[gait]] | ||
*Positive [[Romberg's test]] | *Positive [[Romberg's test]] | ||
*Positive [[Lhermitte's sign]] | *Positive [[Lhermitte's sign]] | ||
*Unilateral/bilateral [[tremor]] | |||
*Unilateral/bilateral tremor | |||
===Extremities=== | ===Extremities=== | ||
* Extremities examination of patients with megaloblastic anemia may show: | * Extremities examination of patients with [[megaloblastic anemia]] may show: | ||
** [[Tremors]] | ** [[Tremors]] | ||
==References== | ==References== | ||
Latest revision as of 22:57, 2 December 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[3] Omer Kamal, M.D.[4]
Overview
Common physical examination findings of megaloblastic anemia include glossitis, pallor, mouth ulcers, vitiligo, subacute combined degeneration, and positive Romberg's sign.
Physical Examination
Physical examination includes the following: [1][2][3]
Appearance of the Patient
- Patients with megaloblastic anemia usually appear pale and fatigued
Vital Signs
- High-grade / low-grade fever
- Tachycardia with regular pulse
- Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
Skin
HEENT
- Pale conjunctiva
- Optic atrophy on fundus exam
- Icterus
- Glossitis
- Mouth ulcers[4]
Neck
- Neck examination of patients with megaloblastic anemia is usually normal but can sometimes show thyromegaly is hypothyroidism or hyperthyroidism are the causes of megaloblastic anemia.
Lungs
- Pulmonary examination of patients with megaloblastic anemia is usually normal.
Heart
- Heave / thrill
- S1, S2 are normal.
- A low grade early systolic murmur at the mitral area can be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with megaloblastic anemia is usually normal but can sometimes show hepatomegaly if liver disease is the cause of megaloblastic anemia.
Back
- Back examination of patients with megaloblastic anemia is usually normal.
Genitourinary
- Genitourinary examination of patients with megaloblastic anemia is usually normal.
Neuromuscular
- Patients are usually oriented to persons, place, and time.
- Hyporeflexia or areflexia
- Positive (abnormal) Babinski / plantar reflex
- Unilateral/bilateral upper/lower extremity weakness
- Can proceed to paraplegia
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Abnormal gait
- Positive Romberg's test
- Positive Lhermitte's sign
- Unilateral/bilateral tremor
Extremities
- Extremities examination of patients with megaloblastic anemia may show:
References
- ↑ Nagao T, Hirokawa M (October 2017). "Diagnosis and treatment of macrocytic anemias in adults". J Gen Fam Med. 18 (5): 200–204. doi:10.1002/jgf2.31. PMC 5689413. PMID 29264027.
- ↑ Shojania AM (May 1980). "Problems in the diagnosis and investigation of megaloblastic anemia". Can Med Assoc J. 122 (9): 999–1004. PMC 1801696. PMID 6768440.
- ↑ Rauw J, Wells RA, Chesney A, Reis M, Zhang L, Buckstein R (October 2011). "Validation of a scoring system to establish the probability of myelodysplastic syndrome in patients with unexplained cytopenias or macrocytosis". Leuk. Res. 35 (10): 1335–8. doi:10.1016/j.leukres.2011.05.001. PMID 21704372.
- ↑ Devalia V, Hamilton MS, Molloy AM (August 2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". Br. J. Haematol. 166 (4): 496–513. doi:10.1111/bjh.12959. PMID 24942828.