Hemolytic anemia physical examination: Difference between revisions
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{{Hemolytic anemia}} | {{Hemolytic anemia}} | ||
{{CMG}} {{shyam}} | {{CMG}}; {{shyam}} | ||
==Overview== | ==Overview== | ||
The physical examination findings of hemolytic anemia reflect (1) [[Red blood cells|red blood cell]] loss and (2) the release of [[hemoglobin]] and its breakdown productions into the [[circulation]]. Typical exam findings include [[jaundice]], [[pallor]], [[splenomegaly]], and [[hepatomegaly]]. | |||
==Physical Examination== | ==Physical Examination== | ||
Exam findings in hemolytic anemia include: | |||
*'''[[Jaundice]]'''<ref name="pmid21814401">{{cite journal| author=Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK| title=Clinical patterns and hematological spectrum in autoimmune hemolytic anemia. | journal=J Lab Physicians | year= 2010 | volume= 2 | issue= 1 | pages= 17-20 | pmid=21814401 | doi=10.4103/0974-2727.66703 | pmc=3147080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21814401 }} </ref>: This is due to | *'''[[Jaundice]]'''<ref name="pmid21814401">{{cite journal| author=Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK| title=Clinical patterns and hematological spectrum in autoimmune hemolytic anemia. | journal=J Lab Physicians | year= 2010 | volume= 2 | issue= 1 | pages= 17-20 | pmid=21814401 | doi=10.4103/0974-2727.66703 | pmc=3147080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21814401 }} </ref>: The symptoms of [[hemolysis]] mostly relate to (1) [[Red blood cells|red blood cell]] loss and (2) release of [[hemoglobin]] and its breakdown products into the [[circulation]]. The breakdown products of [[hemoglobin]] will accumulate in [[Blood|the blood]] causing [[jaundice]] and be excreted in the urine causing the urine to become dark brown in color. This is due to increased serum [[bilirubin]] levels in [[blood]]. [[Bilirubin]] is a breakdown product of [[hemoglobin]]. In one population, 43% of patients with hemolytic anemia presented with [[jaundice]]. [[Hemoglobin]] is first convereted to [[biliverdin]] then [[bilirubin]]. Jaundice can present as yellow discoloration of the [[skin]] or [[mucus membranes]]. It is a reflect of indirect (unconjugated) [[hyperbilirubinemia]]. | ||
*'''[[Pallor]]'''<ref name="pmid21814401">{{cite journal| author=Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK| title=Clinical patterns and hematological spectrum in autoimmune hemolytic anemia. | journal=J Lab Physicians | year= 2010 | volume= 2 | issue= 1 | pages= 17-20 | pmid=21814401 | doi=10.4103/0974-2727.66703 | pmc=3147080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21814401 }} </ref>: This occurs due to anemia and loss of oxygen-carrying ability of blood. Pallor can occur in the [[skin]] or [[mucous membrane]] . In one population, 89% of patients with hemolytic anemia presented with pallor, and this is the most common physical exam finding in hemolytic anemia. | *'''[[Pallor]]'''<ref name="pmid21814401">{{cite journal| author=Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK| title=Clinical patterns and hematological spectrum in autoimmune hemolytic anemia. | journal=J Lab Physicians | year= 2010 | volume= 2 | issue= 1 | pages= 17-20 | pmid=21814401 | doi=10.4103/0974-2727.66703 | pmc=3147080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21814401 }} </ref>: This occurs due to [[anemia]] and loss of [[oxygen]]-carrying ability of [[blood]]. [[Pallor]] can occur in the [[skin]] or [[mucous membrane]] . In one population, 89% of patients with hemolytic anemia presented with pallor, and this is the most common physical exam finding in hemolytic anemia. | ||
*'''[[Splenomegaly]]'''<ref name="pmid21814401">{{cite journal| author=Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK| title=Clinical patterns and hematological spectrum in autoimmune hemolytic anemia. | journal=J Lab Physicians | year= 2010 | volume= 2 | issue= 1 | pages= 17-20 | pmid=21814401 | doi=10.4103/0974-2727.66703 | pmc=3147080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21814401 }} </ref>: In the case of extravascular hemolysis, the spleen can be enlarged. The spleen is the site of destruction of the red blood cells. The spleen tip is measured in centimeters below the left costal margin. Massive splenomegaly can be readily palpated as a firm left-sided abdominal mass, though this is a rare presentation in the case of hemolytic anemia. Massive splenomegaly is more often seen in conditions in which the bone marrow is replaced by fibrous tissue like myelofibrosis, during which the compensatory mechanism is | *'''[[Splenomegaly]]'''<ref name="pmid21814401">{{cite journal| author=Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK| title=Clinical patterns and hematological spectrum in autoimmune hemolytic anemia. | journal=J Lab Physicians | year= 2010 | volume= 2 | issue= 1 | pages= 17-20 | pmid=21814401 | doi=10.4103/0974-2727.66703 | pmc=3147080 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21814401 }} </ref>: In the case of extravascular hemolysis, [[Spleen|the spleen]] can be enlarged. The spleen is the site of destruction of the [[red blood cells]]. The spleen tip is measured in centimeters below the left costal margin. Massive [[splenomegaly]] can be readily palpated as a firm left-sided [[abdominal mass]], though this is a rare presentation in the case of hemolytic anemia. Massive splenomegaly is more often seen in conditions in which [[Bone marrow|the bone marrow]] is replaced by [[fibrous tissue]] like [[myelofibrosis]], during which the compensatory mechanism is [[extramedullary hematopoiesis]] in the [[spleen]]. In one population, 81% of patients with hemolytic anemia presented with splenomegaly. | ||
*'''[[Hepatomegaly]]''': Hepatomegaly, or liver enlargement, is a relatively uncommon presentation of hemolytic anemia. In one population, 76% of patients with hemolytic anemia presented with hepatomegaly. Hepatomegaly is measured in centimeters below the right costal margin. | *'''[[Hepatomegaly]]''': Hepatomegaly, or [[liver enlargement]], is a relatively uncommon presentation of hemolytic anemia. In one population, 76% of patients with hemolytic anemia presented with hepatomegaly. Hepatomegaly is measured in centimeters below the right costal margin. | ||
*'''[[Fever]]''': This can be a rare manifestation of hemolytic anemia. Fever is not specific for hemolysis. In one population, 38% of patients with hemolytic anemia presented with fever. | *'''[[Fever]]''': This can be a rare manifestation of hemolytic anemia. Fever is not specific for [[hemolysis]]. In one population, 38% of patients with hemolytic anemia presented with [[fever]]. | ||
==References== | ==References== | ||
Latest revision as of 14:11, 31 October 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]
Overview
The physical examination findings of hemolytic anemia reflect (1) red blood cell loss and (2) the release of hemoglobin and its breakdown productions into the circulation. Typical exam findings include jaundice, pallor, splenomegaly, and hepatomegaly.
Physical Examination
Exam findings in hemolytic anemia include:
- Jaundice[1]: The symptoms of hemolysis mostly relate to (1) red blood cell loss and (2) release of hemoglobin and its breakdown products into the circulation. The breakdown products of hemoglobin will accumulate in the blood causing jaundice and be excreted in the urine causing the urine to become dark brown in color. This is due to increased serum bilirubin levels in blood. Bilirubin is a breakdown product of hemoglobin. In one population, 43% of patients with hemolytic anemia presented with jaundice. Hemoglobin is first convereted to biliverdin then bilirubin. Jaundice can present as yellow discoloration of the skin or mucus membranes. It is a reflect of indirect (unconjugated) hyperbilirubinemia.
- Pallor[1]: This occurs due to anemia and loss of oxygen-carrying ability of blood. Pallor can occur in the skin or mucous membrane . In one population, 89% of patients with hemolytic anemia presented with pallor, and this is the most common physical exam finding in hemolytic anemia.
- Splenomegaly[1]: In the case of extravascular hemolysis, the spleen can be enlarged. The spleen is the site of destruction of the red blood cells. The spleen tip is measured in centimeters below the left costal margin. Massive splenomegaly can be readily palpated as a firm left-sided abdominal mass, though this is a rare presentation in the case of hemolytic anemia. Massive splenomegaly is more often seen in conditions in which the bone marrow is replaced by fibrous tissue like myelofibrosis, during which the compensatory mechanism is extramedullary hematopoiesis in the spleen. In one population, 81% of patients with hemolytic anemia presented with splenomegaly.
- Hepatomegaly: Hepatomegaly, or liver enlargement, is a relatively uncommon presentation of hemolytic anemia. In one population, 76% of patients with hemolytic anemia presented with hepatomegaly. Hepatomegaly is measured in centimeters below the right costal margin.
- Fever: This can be a rare manifestation of hemolytic anemia. Fever is not specific for hemolysis. In one population, 38% of patients with hemolytic anemia presented with fever.
References
- ↑ 1.0 1.1 1.2 Alwar V, Shanthala DA, Sitalakshmi S, Karuna RK (2010). "Clinical patterns and hematological spectrum in autoimmune hemolytic anemia". J Lab Physicians. 2 (1): 17–20. doi:10.4103/0974-2727.66703. PMC 3147080. PMID 21814401.