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Chronic Anemia Clinical Presentation

  • Author: Christopher D Braden, DO; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
 
Updated: Feb 01, 2016
 

History

A comprehensive history and physical examination are vital in determining the cause of anemia. For example, a family history of a dominant inheritance pattern would suggest spherocytosis. In addition, knowing what medications the patient is taking is vital, as many drugs and toxins can cause anemia (eg, alcohol, isoniazid, lead).

The spectrum of symptoms manifested by anemia is dependent on many factors, including underlying medical condition, medications, rate of onset, and the individual's ability to compensate for the deficit. The hallmark of chronic anemia is the ability of patients to sustain a relatively normal level of function at significantly lower than normal Hgb levels.

Primary symptoms result from tissue hypoxia and might include the following:

  • Fatigue, weakness, irritability
  • Headache
  • Dizziness, especially postural
  • Vertigo
  • Tinnitus
  • Syncope
  • Dyspnea, especially with increased physical activity (exercise intolerance)
  • Chest pain, palpitations
  • Difficulty sleeping or concentrating
  • Thirst
  • Anorexia
  • Decreased urine output/bowel irregularity
  • Decreased libido or impotence
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Physical Examination

Physical findings mirror the underlying disease process and the duration from the onset. Patients with chronic anemia usually do not manifest typical physical findings associated with acute anemia.

The usefulness of skin pallor as a sign is limited by the color of the skin, the Hgb concentration, and the fluctuation of blood flow to the skin. The color of the palmar creases is a better indicator. If they are as pale as the surrounding skin, Hgb is usually less than 7 g/dL. Patients also may exhibit purpura, petechiae, and jaundice.

Ocular findings may include the following:

  • Pale conjunctiva
  • Retinal hemorrhages

Cardiovascular findings may include the following:

  • Tachycardia
  • Orthostatic hypotension

Pulmonary findings may include the following:

  • Tachypnea
  • Rales

Abdominal findings may include the following:

  • Hepatomegaly and/or splenomegaly
  • Ascites
  • Masses
  • Positive result on Hemoccult test

Neurologic findings may include the following:

  • Peripheral neuritis/neuropathy
  • Mental status changes
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Contributor Information and Disclosures
Author

Christopher D Braden, DO Hematologist/Oncologist, Chancellor Center for Oncology at Deaconess Hospital

Disclosure: Nothing to disclose.

Coauthor(s)

Eric Wilke, MD Medical Director, Traditions Emergency Medicine, College Station Medical Center

Eric Wilke, MD is a member of the following medical societies: American College of Emergency Physicians, Texas Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director for Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha, American Heart Association, American Thoracic Society, Arkansas Medical Society, New York Academy of Medicine, New York Academy of Sciences, Society for Academic Emergency Medicine, American Academy of Emergency Medicine, American College of Chest Physicians, American College of Emergency Physicians, American College of Physicians

Disclosure: Nothing to disclose.

Additional Contributors

Roy Alson, MD, PhD, FACEP, FAAEM Associate Professor, Department of Emergency Medicine, Wake Forest University School of Medicine; Medical Director, Forsyth County EMS; Deputy Medical Advisor, North Carolina Office of EMS; Associate Medical Director, North Carolina Baptist AirCare

Roy Alson, MD, PhD, FACEP, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, World Association for Disaster and Emergency Medicine, National Association of EMS Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Fredrick Melik Abrahamian, DO, FACEP,to the development and writing of the source article.

References
  1. McLennan JD, Steele M. Extent of microcytic anemia among children in a low-income, peri-urban community in the Dominican Republic using different cut-points. J Trop Pediatr. 2015 Apr. 61 (2):86-91. [Medline].

  2. [Guideline] American College of Obstetricians and Gynecologists (ACOG). Anemia in pregnancy. 2008 Jul. [Full Text].

  3. Zittermann A, Jungvogel A, Prokop S, Kuhn J, Dreier J, Fuchs U, et al. Vitamin D deficiency is an independent predictor of anemia in end-stage heart failure. Clin Res Cardiol. 2011 Apr 7. [Medline].

  4. Omar N, Salama K, Adolf S, El-Saeed GS, Abdel Ghaffar N, Ezzat N. Major risk of blood transfusion in hemolytic anemia patients. Blood Coagul Fibrinolysis. 2011 Apr 19. [Medline].

  5. Gao C, Li L, Chen B, Song H, Cheng J, Zhang X, et al. Clinical outcomes of transfusion-associated iron overload in patients with refractory chronic anemia. Patient Prefer Adherence. 2014. 8:513-7. [Medline].

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