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 about medication use and toxin exposure is vital, as many drugs and toxins can cause anemia (eg, alcohol, isoniazid, lead).
The spectrum of symptoms manifested by anemia depends 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 hemoglobin levels that are significantly lower than normal.
Primary symptoms result from tissue hypoxia and might include the following:
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Fatigue, weakness, irritability
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Headache
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Dizziness, especially postural
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Vertigo
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Tinnitus
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Syncope
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Dyspnea, especially with increased physical activity (exercise intolerance)
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Chest pain, palpitations
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Difficulty sleeping or concentrating
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Thirst
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Anorexia
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Decreased urine output/bowel irregularity
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Decreased libido or impotence
Physical Examination
Physical findings mirror the underlying disease process and the duration from the onset. Patients with chronic anemia usually do not manifest the physical findings typically associated with acute anemia.
The usefulness of skin pallor as a sign is limited by the color of the skin, the hemoglobin 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, the hemoglobin concentration is usually less than 7 g/dL. Patients also may exhibit purpura, petechiae, and jaundice.
Ocular findings may include the following:
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Pale conjunctivae
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Retinal hemorrhages
Cardiovascular findings may include the following:
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Tachycardia
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Orthostatic hypotension
Pulmonary findings may include the following:
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Tachypnea
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Rales
Abdominal findings may include the following:
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Hepatomegaly and/or splenomegaly
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Ascites
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Masses
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Positive result on a guaiac-based fecal occult blood test
Neurologic findings may include the following:
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Peripheral neuritis/neuropathy
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Mental status changes
