Anaemia: clinical examination was not very helpful.

Clinical bottom line (level 4)

  1. Anaemia was more likely in patients with koilonychia (LR+5.6) , recent pallor (LR+2.2) , diarrhoea (LR+1.7) or paraesthesiae (LR+1.7) .
  2. Other clinical signs and symptoms are not very helpful.
Dawson et al: British Medical Journal 1969; 3: 436-439
Expires June 2003

The study

Setting: university hospital, UK

133 patients (aged ?, ?% male) chronic iron deficiency anaemia, acute blood loss, chronic renal failure, marrow infiltration, vitamin B12 deficiency or folate deficiency

Independent ?blinded reference standard, applied in all patients from a non-consecutive ?appropriate spectrum.
Reference standard:
  • haemoglobin within three days of examination- considered anaemic if <8.0 mmol/l
Diagnostic test: clinical assessment of anaemia by two examiners- based on inspection of skin, nails and conjunctivae

The evidence


diagnostic test anaemia no anaemia LR+
(95% CI)		 post-test probability LR-
(95% CI)		 post-test probability
recent pallor 53 27 2.18
(1.59 to 2.99) 		66% 0.26
(0.14 to 0.47) 		19%
fatigue 57 59 1.1
(0.94 to 1.2) 		49% 0.61
(0.24 to 1.5) 		35%
recent headache 12 10 1.3
(0.62 to 2.9) 		55% 0.94
(0.81 to 1.1) 		46%
recent insomnia 14 12 1.3
(0.65 to 2.6) 		54% 0.94
(0.79 to 1.1) 		46%
paraesthesiae 14 9 1.7
(0.80 to 3.7) 		61% 0.89
(0.76 to 1.1) 		45%
dizziness 34 28 1.4
(0.94 to 2.0) 		55% 0.77
(0.55 to 1.1) 		41%
dyspnoea 40 34 1.3
(0.96 to 1.8) 		54% 0.71
(0.48 to 1.1) 		39%
ankle swelling 21 20 1.2
(0.70 to 1.9) 		51% 0.93
(0.74 to 1.2) 		46%
angina 10 13 0.85
(0.40 to 1.8) 		43% 1.0
(0.88 to 1.2) 		48%
palpitations 18 15 1.3
(0.74 to 2.4) 		55% 0.91
(0.75 to 1.1) 		45%
anorexia 33 27 1.4
(0.93 to 2.0) 		55% 0.78
(0.56 to 1.1) 		41%
dyspepsia 16 24 0.74
(0.43 to 1.3) 		40% 1.1
(0.91 to 1.4) 		51%
recent constipation 11 9 1.4
(0.60 to 3.1) 		55% 0.95
(0.82 to 1.1) 		46%
diarrhoea 14 9 1.7
(0.80 to 3.7) 		61% 0.89
(0.76 to 1.1) 		45%
weight loss 33 25 1.5
(0.99 to 2.2) 		57% 0.74
(0.54 to 1.0) 		40%
painful tongue 10 8 1.4
(0.58 to 3.3) 		56% 0.95
(0.83 to 1.1) 		46%
koilonychia 5 1 5.6
(0.67 to 46) 		83% 0.93
(0.86 to 1.0) 		46%
total 63 70

Comments

  1. Pre and post-test probabilities are meaningless in a preselected group.
  2. Patients had such a wide diversity of causes of anaemia that there is a possibility that useful signs in certain situations (eg. acute blood loss) are not demonstrated.

Citation

  1. Dawson AA, Ogston D, Fullerton HW: Evaluation of diagnostic significance of certain symptoms and physical signs in anaemic patients. British Medical Journal 1969; 3: 436-439
Contributor: Chris Ball and Clare Wotton, June 2000
Reviewer: Daniel Sontheimer

Clinical Question.
Patient anaemia, blood loss, renal filtration etc.
Intervention or Exposure clinical signs
Comparison haemoglobin
Outcome diagnosis of anaemia