Macrocytic anemia physical examination
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Appearance of the Patient
- Patients with megaloblastic anemia usually appear pale and fatigued
- High-grade / low-grade fever
- Tachycardia with regular pulse
- Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
- Neck examination of patients with megaloblastic anemia is usually normal but can sometimes show thyromegaly is hypothyroidism or hyperthyroidism are the causes of megaloblastic anemia.
- Pulmonary examination of patients with megaloblastic anemia is usually normal.
- Heave / thrill
- S1, S2 are normal.
- A low grade early systolic murmur at the mitral area can be heard using the bell/diaphgram of the stethoscope
- Abdominal examination of patients with megaloblastic anemia is usually normal but can sometimes show hepatomegaly if liver disease is the cause of megaloblastic anemia.
- Back examination of patients with megaloblastic anemia is usually normal.
- Genitourinary examination of patients with megaloblastic anemia is usually normal.
- Patients are usually oriented to persons, place, and time.
- Hyporeflexia or areflexia
- Positive (abnormal) Babinski / plantar reflex
- Unilateral/bilateral upper/lower extremity weakness
- Can proceed to paraplegia
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Abnormal gait
- Positive Romberg's test
- Positive Lhermitte's sign
- Unilateral/bilateral tremor
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- Shojania AM (May 1980). "Problems in the diagnosis and investigation of megaloblastic anemia". Can Med Assoc J. 122 (9): 999–1004. PMC 1801696. PMID 6768440.
- Rauw J, Wells RA, Chesney A, Reis M, Zhang L, Buckstein R (October 2011). "Validation of a scoring system to establish the probability of myelodysplastic syndrome in patients with unexplained cytopenias or macrocytosis". Leuk. Res. 35 (10): 1335–8. doi:10.1016/j.leukres.2011.05.001. PMID 21704372.
- Devalia V, Hamilton MS, Molloy AM (August 2014). "Guidelines for the diagnosis and treatment of cobalamin and folate disorders". Br. J. Haematol. 166 (4): 496–513. doi:10.1111/bjh.12959. PMID 24942828.