Hemolytic anemia physical examination

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Shyam Patel [2]

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.

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.

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