Macrocytic anemia physical examination

Common physical examination findings of megaloblastic anemia include glossitis, pallor, mouth ulcers, vitiligo, subacute combined degeneration, and positive Romberg’s sign.

Physical examination includes the following: ^[1][2][3]

• 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

• Pallor
• Vitiligo– in autoimmune diseases related to pernicious anemia
• Jaundice

• Pale conjunctiva
• Optic atrophy on fundus exam
• Icterus
• Glossitis
• Mouth ulcers^[4]

• 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
  • Position and vibration sense is impaired
• Abnormal gait
• Positive Romberg’s test
• Positive Lhermitte’s sign
• Unilateral/bilateral tremor

• Extremities examination of patients with megaloblastic anemia may show:
  • Tremors

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