Macrocytic anemia physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2] Omer Kamal, M.D.[3]
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 can be seen on fundus exam
- Icterus can be seen
- Glossitis
- Mouth ulcers[4]
Neck
- Neck examination of patients with megaloblastic anemia is usually normal.
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.
Back
- Back examination of patients with megaloblastic anemia is usually normal.
Genitourinary
- Genitourinary examination of patients with megaloblastic anemia is usually normal.
Neuromuscular
- Patient is usually oriented to persons, place, and time
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Can proceed to paraplegia
- Unilateral/bilateral sensory loss in the upper/lower extremity
- 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:
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.