From the Guidelines
On a physical exam of a patient with anemia, you would typically find pallor of the skin, mucous membranes, and conjunctiva due to reduced hemoglobin levels. The patient may exhibit tachycardia and a hyperdynamic precordium as the heart works harder to compensate for decreased oxygen-carrying capacity 1. You might hear a systolic flow murmur on cardiac auscultation. Patients often appear fatigued and may demonstrate shortness of breath with exertion. In severe cases, you might observe tachypnea at rest.
Depending on the cause of anemia, you could find additional findings, such as:
- Jaundice in hemolytic anemia
- Koilonychia (spoon-shaped nails) in iron deficiency, as iron is essential for the production of hemoglobin and other cellular proteins 1
- Glossitis (smooth, red tongue) in B12 or folate deficiency
- Splenomegaly in hemolytic conditions
- Petechiae or ecchymoses might be present in aplastic anemia or other bone marrow disorders.
The physical exam helps not only confirm anemia but also provides clues to its underlying etiology, which is crucial for appropriate management, including iron replacement therapy (IRT) and investigation to establish the underlying cause 1.
From the Research
Physical Exam Findings in Anemia
On a physical exam of a patient with anemia, the following findings may be observed:
- Splenomegaly (enlarged spleen) 2, 3
- Jaundice (yellowing of the skin and eyes) 2, 3
- Pallor (pale skin)
- Signs of heart failure or increased cardiac output, such as tachycardia (rapid heart rate) or a systolic ejection murmur
- In some cases, patients may have a normal physical exam, especially if the anemia is mild
Specific Findings in Hereditary Spherocytosis
In patients with hereditary spherocytosis, a type of anemia, the following physical exam findings may be present:
- Splenomegaly 2, 3
- Jaundice 2, 3
- Gallstones (cholelithiasis) 2, 3
- Signs of hemolysis, such as increased bilirubin levels
It is essential to note that the physical exam findings may vary depending on the severity and type of anemia, as well as the presence of any underlying conditions. The studies provided primarily focus on hereditary spherocytosis, and the findings may not be generalizable to all types of anemia 4, 5, 6.