Clinical features

• recent bleeds ^{a b}
• recent onset pallor ^c  
• menstrual loss ^b  
• diet and alcohol use ^{b c}
• weight loss (> 7 kg in 6 months) ^c  
• family history of anaemia ^d
• history of gastrectomy (for B₁₂ deficiency) ^b or other bowel resection ^c  
• upper gastrointestinal symptoms (dysphagia, heartburn, nausea, vomiting) ^c  
• lower gastrointestinal symptoms (altered bowel habit, rectal bleeding, pain relieved by defecation) ^c  

Do not bother asking about the following - these features are little help at diagnosing or excluding anaemia  ^c

• fatigue 
• dizziness or palpitations 
• angina 
• a painful tongue 
• diarrhoea or recent constipation 

Look for 

• conjunctival pallor ^a  
• facial pallor ^b  
• palmar pallor ^b

  The more that are present, the greater the chance of anaemia . ^b

   

• dyspnoea ^c  
• evidence of acute bleeding ^b  
  • supine tachycardia (pulse > 100 beats/minute) 
  • supine hypotension (systolic blood pressure < 95 mmHg) 
  • postural pulse increase of ≥ 30 beats/min or severe dizziness on sitting upright, then on standing

• koilonychia ^c  
• evidence of heart failure ^d
• jaundice (suggesting haemolytic or megaloblastic anaemia ) ^d
• evidence of infection or spontaneous bruising (suggesting marrow failure) ^d
• abdominal or rectal masses ^d
  

Do not bother looking for the following - these features are little help at diagnosing or excluding anaemia

• nailbed pallor ^b  
• palmar crease pallor  ^b