Anemia physical examination

Anemia main page
Overview
Classification
Differential Diagnosis
Medical Therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Anemia goes undetected in many people, and symptoms can be vague. The signs and symptoms are similar in different types of anemia. The presentation may vary depending on the acuteness of onset, hematocrit levels, and the general health conditions of the patient (age, sex, pregnancy, cardiac conditions, and any other comorbidities) rather than only the etiology behind the anemia. A hematocrit level of between 30 - 35 usually produces no symptoms whereas, a fall of heamtocrit levels to 15 - 20 may produce severe symptoms (shortness of breath, syncope). However, most patients will experience some symptoms related to anemia when the hemoglobin level reaches 7 g/dL.

Physical Examination

Appearance of the Patient

• Pallor (pale skin, mucosal linings and nail beds) is often a useful diagnostic sign in moderate or severe anemia, but it is not always apparent. Commonly seen in nail bed, palm crease, and conjunctiva.

Physical Findings Associated with Specific Anemia

Iron deficiency anemia

• Cheilosis
• Koilonychia
• Glossitis

Iron Deficiency Anemia Secondary to Bleeding

• Melena
• Hematochezia
• Hematuria
• Hematemesis

Iron Deficiency Anemia Secondary to Malabsorption

• Dermatitis herpetiformis

Vitamin B12 Deficiency

• Chelitis
• Glossitis
• Decreased proprioception, and vibratory sensation

Hematological Malignancy (Leukemia, Lymphoma)

• Lymphadenopathy
• Splenomegaly
• Purpura
• Ecchymoses