Anemia Clinical Clues

Aka: Anemia Clinical Clues, Anemia History, Anemia Examination, Anemia Signs

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II. History

  1. See Iron Deficiency Anemia for related history
  2. Family History of Anemia
    1. Hereditary Spherocytosis
    2. Sickle Cell Anemia (Black patients)
    3. Thalassemia (Asian, Black, or Mediterranean patients)
    4. Other Hemoglobinopathy
    5. Glucose-6-Phosphate Dehydrogenase Deficiency (G6PD)
      1. Black, Greek, Filipino, Jewish, Sardinian patients
      2. X-linked inheritance (consider in males)
  3. History of chronic illness (Anemia of Chronic Disease)
    1. Chronic infection
    2. Collagen vascular disease
    3. Malignancy
    4. Hypothyroidism
    5. Hypoadrenalism
    6. Renal disease
    7. Hypopituitarism
  4. Dietary habits
    1. Inadequate Iron or Protein intake: Iron Deficiency
    2. Strict Vegetarian: Vitamin B12 Deficiency
    3. Diet lacking fruits and vegetables: Folate Deficiency
  5. History of Gastrectomy or Malabsorption (e.g. Diarrhea)
    1. Vitamin B12 Deficiency
    2. Iron Deficiency Anemia
    3. Folate DeficiencyAnemia
  6. Recent Infection
    1. Parvovirus: Erythroblastopenia
    2. Hepatitis: Aplastic Anemia
  7. Medications
    1. See Medication Causes of Macrocytic Anemia
    2. Oxidant medications provoke G6PD
  8. Abdominal Pain
    1. Peptic Ulcer Disease
    2. Lead Toxicity
    3. Porphyria
  9. Pica
    1. Suggests Iron Deficiency Anemia

III. Symptoms

  1. Many patients are asymptomatic
    1. Mild Anemia (Hemoglobin over 10 g/dl)
    2. Gradual onset of Anemia
    3. Active, well-conditioned persons
  2. Non-specific Symptoms
    1. Fatigue
    2. Generalized weakness
    3. Dyspnea on exertion
    4. Light headed
    5. Pruritus (Iron Deficiency Anemia)

IV. Signs: Anemia

  1. Vital Signs
    1. Tachycardia
    2. Systolic Murmur (ejection murmur)
  2. Thorough, systematic exam for Anemia cause
    1. Abdominal and pelvic exam
    2. Rectal Exam with Stool Guaiac for occult blood
  3. Pallor in severe Anemia (Hct <25%, Hgb <7 g/dl)
    1. Pale Conjunctiva or mucous membranes
    2. Pallor at the nail beds or palmar creases

V. Signs: Clinical Clues

  1. Jaundice
    1. Hemolytic Anemia
    2. Hepatitis
  2. Angular Cheilitis
    1. Iron Deficiency Anemia
  3. Glossitis
    1. Iron Deficiency Anemia
    2. Vitamin B12 Deficiency
    3. Folate Deficiency Anemia
  4. Splenomegaly
    1. Chronic Hemolytic Anemia
    2. Acute infection
    3. Leukemia
    4. Lymphoma
    5. Portal Hypertension
  5. Frontal bossing with prominent malar and Maxillary Bone
    1. Chronic Hemolytic Anemia
  6. Neurologic changes (Dementia, Ataxia, Paresthesias)
    1. Vitamin B12 Deficiency

VI. References

  1. Oblender in Daeschner (1991) Pediatrics, p. 281
  2. Irwin (2001) Am Fam Physician 64(8):1379-86 [PubMed]

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