Autoimmune hemolytic anemia physical examination

Physical exam findings in patients with autoimmune hemolytic anemia vary depending on the severity of the disease. Examination findings include pallor, clubbing, jaundice, scleral icterus, splenomegaly, and abdominal tenderness.

Physical exam findings relate to the effects of decreased hemoglobin, the release of bilirubin into the bloodstream, and the presence of either intravascular or extravascular hemolysis.^[1]

• Pallor:
  • Pallor is the absence of normal coloration of body tissues. Patients can have pale skin or conjunctiva.
• Clubbing:
  • Clubbing refers to an irregular shape of fingernails that reflects an underlying oxygen deficit.
• Jaundice:
  • Jaundice refers to the presence of yellowish discoloration of the skin.
  • Jaundice is due to indirect (unconjugated) hyperbilirubinemia, which is a result of the breakdown of heme to biliverdin then to bilirubin. This results in bilirubin deposition in tissue.
• Scleral icterus:
  • This refers to yellowish discoloration of the conjunctiva. This is due to bilirubin deposition, similar to the physiology of jaundice.
• Splenomegaly: Splenomegaly is enlargement of the spleen, which occurs in the presence of extravascular hemolysis. Extravascular hemolysis is mediated by IgG autoantibodies which binds to red blood cells, and these antibody-coated red blood cells and engulfed by splenic macrophages. Patients can have tender splenomegaly. Ultrasound or CT of the abdomen can be used as an adjunct to the physical exam to accurately assess spleen size.
• Abdominal tenderness: Mesenteric thrombosis (such as clots in the portal or splenic veins) can result in abdominal tenderness. Thrombosis can occur in patients with active hemolysis.

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