From the Guidelines
Physical exam findings of anemia include pallor of the skin, mucous membranes, and conjunctiva, which results from decreased hemoglobin concentration in the blood, as well as tachycardia, a hyperdynamic precordium, and a systolic flow murmur, as noted in various studies 1. The physical examination of a patient with anemia can reveal a range of signs and symptoms, depending on the severity, chronicity, and underlying cause of the anemia.
- Key findings may include:
- Pallor of the skin, mucous membranes, and conjunctiva
- Tachycardia and a hyperdynamic precordium as the heart compensates for reduced oxygen-carrying capacity
- A systolic flow murmur due to increased blood flow velocity and decreased blood viscosity
- Brittle, spoon-shaped nails (koilonychia), angular cheilitis, and glossitis in severe cases
- Signs of heart failure, such as peripheral edema, jugular venous distention, and pulmonary crackles, in more severe or chronic cases
- Hepatosplenomegaly in certain types of anemia, such as hemolytic anemia or thalassemia
- Jaundice in hemolytic anemias due to increased bilirubin from red blood cell destruction These physical findings can vary based on the underlying cause of anemia, with mild anemia often having minimal physical exam abnormalities, as discussed in the guidelines for the management of iron deficiency anemia 1. The most recent and highest quality study, published in 2021, emphasizes the importance of a thorough physical examination and laboratory evaluation in diagnosing and managing anemia, particularly iron deficiency anemia 1.
From the Research
Physical Exam Findings of Anemia
The physical exam findings of anemia can vary, but some common signs include:
- Pallor of the conjunctivae, nail beds, lips, oral mucosa, and palmar creases 2
- Fatigue and weakness 3
- Shortness of breath 3
Diagnostic Accuracy of Physical Exam Techniques
The diagnostic accuracy of physical exam techniques for anemia can range widely, with sensitivity and specificity varying depending on the technique and population being studied 4. For example:
- Pallor assessments of conjunctivae have a sensitivity of 19-97% and specificity of 65-100% 4
- Nailbed assessments have a sensitivity of 41-65% and specificity of 58-93% 4
- Palmar assessments have a sensitivity of 33-91% and specificity of 54-93% 4
Combining Physical Exam Techniques
Combining multiple physical exam techniques can lead to higher sensitivity and specificity, with examining 9 or more sites resulting in higher accuracy measures 4. However, the choice of techniques and number of sites examined should be balanced with the time available for examination.
Laboratory Evaluation
In addition to physical exam findings, laboratory evaluation is essential for diagnosing anemia, with a complete blood count (CBC) and mean corpuscular volume (MCV) providing important clues to the classification and cause of anemia 3, 5. Other laboratory tests, such as reticulocyte count, iron panel, and vitamin B12 and folate levels, may also be necessary to determine the underlying cause of anemia 3, 5, 6.