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==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 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===
*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===
* [[Pallor]]
* [[Vitiligo]]- in autoimmune diseases related to pernicious anemia
* [[Jaundice]]
 
===HEENT===
* Pale [[conjunctiva]]
* [[Optic atrophy]] on fundus exam
* [[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 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]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]], [[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|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's Reflex|Babinski]] / [[plantar]] reflex
*Unilateral/bilateral upper/lower extremity [[weakness]]
**Can proceed to [[paraplegia]]
*Unilateral/bilateral [[sensory loss]] in the upper/lower extremity
**[[Positional nystagmus|Position]] and [[vibration]] sense is impaired
*Abnormal [[gait]]
*Positive [[Romberg's test]]
*Positive [[Lhermitte's sign]]
*Unilateral/bilateral [[tremor]]
 
===Extremities===
* Extremities examination of patients with [[megaloblastic anemia]] may show:
** [[Tremors]]
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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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

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

Heart

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

Extremities

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.


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