Clinical features of Iron deficiency anemia

Insidious onset of symptoms with gradual progression is seen.

There will be symptoms of anemia.

Fatigue is the most common complaint.

Other symptoms are irritability, palpitations, breathlessness, dizziness and headache.

Usually people seeks medical attention when Hb is below 7-8 g/dl.

Neuromuscular manifestations of anemia 

Attention deficit, cognitive dysfunction. occasionally - neuralgic pains, numbness and tingling are seen. Rarely raised intrcranialtension & papilledema 

Nail changes in iron defiency

Nails are brittle,fragile and longitudinally ridged.Tytpical thinning ,flattening and koilonychias are seen 

Changes in oral mucosa

1. Atrophy of lingual papillae
2. Filiform (in ant 2/3rd) - first to get atrophied
3. Soreness and burning of tongue
4. Glossitis 
5. Smooth , waxy and glistening tongue
6. Changes reversed after 1-2 wks of iron therapy
7. Angular stomatitis which is also seen in riboflavin & B6 deficiency
8. Dysphagia called as sideropenic dysphagia (paterson-kelly syndrome or Plummer-vinson syndrome)
9. Stomach there is  gastritis & later atrophy
10. Antibodies to gastric parietal cells are seen in in 1/3rd of cases

PICA - habitual ingestion of unusual substances. Eg - pagophagia - purposeful eating of ice is seen in iron deficiency anemia.

Spleen tip is palpable in 10% cases 

Disturbances in menstruation can occur in females

Skeletal changes are observed in children

In cases of long standing Fe deficiency, Diploic spaces are widened, outer tables are thinned

Rarely - hair-on-end appearance is seen.

What are the clinical features of hemophilia?

Hemophilia is a coagulation disorder which manifest as increased bleeding due to defective clot formation.In mild disease there is infrequent bleeding that is secondary to trauma.

In severe cases there is haemarthrosis, bleeding into soft tissues, muscles  which can be either spontaneous or secondary to minor trauma.

Earliest  bleeding manifestation are seen when the child begins to crawl or walk.

Some people manifest it as increased bleeding after minor surgical procedures.

Joint bleed or hemarthrosis

Severe forms as recurrent haemarthroses are seen in severe factor deficiency.

Common sites of joint bleed are knee,elbows,ankles, hip and shoulders.

Painful local swelling and erythema can occur due to superficial bleed.

Joint bleed may lead to inactivity decreased joint mobility, neutral fixed position may lead to contractures.

Chronic haemarthroses can lead to synovitis.

Vicious cycle of bleeding lead to deformity.

Muscle hematoma 

Large bleed in to the muscle will lead to Compartment syndrome.The haematomas in distal parts of limbs leading to compression of arteries,veins and nerves.

Dangerous sites of bleeding are Oropharyngeal spaces, CNS, retroperitoneum -  These bleed are very fatal.

Pseudotumour syndrome…retro peritoneal bleeding with mass,calcification and inflammation may mimic tumor

Damage to femoral nerve.

Pseudotumours in long bones of lower limbs can damage femoral nerve due to pressure effect.

Haematuria in the absence of genito-urinary pathology can occur in hemophilia.

Classification of hemophilia based on residual activity of factors

Mild -6-30 %

Moderate - 1-5 %

Severe  < 1 %

Clinical manifestations usually correlate with activity of residual clotting factor.

Hypercoagulable disorders

Following are examples of hypercoagulable situations

1. Protein C deficiency
2. Protein S deficiency
3. Antithrombin III deficiency
4. Antiphospholipid syndrome
5. Factor V Leiden mutation
6. Prothrombin G20210 mutation
7. Systemic malignancy
8. Sickle cell anemia
9. ß-Thalassemia
10. Polycythemia vera
11. Systemic lupus erythematosus
12. Homocysteinemia
13. Thrombotic thrombocytopenic purpura
14. Disseminated intravascular coagulation
15. Dysproteinemias
16. Nephrotic syndrome
17. Inflammatory bowel disease
18. Oral contraceptives