Clinical Features

• Asymptomatic

• Exertional dyspnea and fatigue

• Worsening of angina pectoris

• Pallor (e.g., on mucous membranes, conjunctivae)

• Growth impairment (chronic anemia)

Severe anemia can lead to cardiac ischemia if the oxygen demand of the myocardium is not met (e.g., demand ischemia).

• Clinical features of shock (if anemia is acute)

• Features of IDA: pica (craving for ice or dirt), brittle nails, angular cheilitis, atrophic glossitis

• Features of megaloblastic anemia: oral sores, mucosal bleeding, paresthesias, ataxia

• Clinical features of hemolysis

• Signs of hemorrhage: e.g., GI bleeding, menorrhagia

• Features of hyperdynamic state

• Features of extramedullary hematopoiesis may be present in certain severe, chronic forms of anemia (e.g., thalassemia, myelofibrosis).

• Bounding pulses

• Tachycardia/palpitations

• Flow murmur

• Pulsatile sound in the ear

• Possibly heart failure (anemia-induced heart failure)

• Hepatosplenomegaly

• Paravertebral mass

• Widening of diploic spaces of the skull