EDITOR – Logan and Delaney, in their recent article1 and in an
earlier report by the latter author2, drew attention to those clinical
features in a patient with dyspepsia that should give cause for concern
lest the patient have upper gastrointestinal tract cancer. Among them,
utilisation of the term anaemia as an ‘alarm symptom’ is open to
interpretation. Does it indicate that the patient has symptoms consistent
with being anaemic, e.g. dyspnoea and fatigue? Or that clinical
examination reveals signs implying the patient is anaemic, e.g. pale
mucous membranes, angular stomatitis, and koilonychia? Or does it imply
that the patient has a haemoglobin concentration less than the lower limit
of normal, i.e. an abnormal laboratory parameter, in association with
dyspeptic symptoms?
Most physicians would understand use of the term anaemia as an ‘alarm
symptom’ to denote either physical signs of anaemia, or a low haemoglobin
concentration. (In the second of these categories a patient with dyspepsia
and proven anaemia may be referred urgently for specialist appraisal on
the basis of suspected upper gastrointestinal tract cancer). However, in
neither of these circumstances is anaemia a symptom.
At a time when it appears difficult for junior colleagues and medical
students to distinguish clearly between patient symptoms and physical
signs, e.g. dyspnoea and tachypnoea3, would it not be better to employ the
term ‘alarm feature’ rather than ‘alarm symptom’ when referring to anaemia
in the context of assessment of the patient who has dyspepsia.
Alastair D Smith consultant physician and gastroenterologist
Department of Medicine,
Eastbourne District General Hospital,
Kings Drive,
Eastbourne
BN21 2UD
1. Logan RFA, Delaney BC. ABC of the gastrointestinal tract:
Implications of dyspepsia for the NHS. BMJ 2001; 323: 675-7. (22
September)
Rapid Response:
Anaemia: alarm symptom or alarm feature?
EDITOR – Logan and Delaney, in their recent article1 and in an
earlier report by the latter author2, drew attention to those clinical
features in a patient with dyspepsia that should give cause for concern
lest the patient have upper gastrointestinal tract cancer. Among them,
utilisation of the term anaemia as an ‘alarm symptom’ is open to
interpretation. Does it indicate that the patient has symptoms consistent
with being anaemic, e.g. dyspnoea and fatigue? Or that clinical
examination reveals signs implying the patient is anaemic, e.g. pale
mucous membranes, angular stomatitis, and koilonychia? Or does it imply
that the patient has a haemoglobin concentration less than the lower limit
of normal, i.e. an abnormal laboratory parameter, in association with
dyspeptic symptoms?
Most physicians would understand use of the term anaemia as an ‘alarm
symptom’ to denote either physical signs of anaemia, or a low haemoglobin
concentration. (In the second of these categories a patient with dyspepsia
and proven anaemia may be referred urgently for specialist appraisal on
the basis of suspected upper gastrointestinal tract cancer). However, in
neither of these circumstances is anaemia a symptom.
At a time when it appears difficult for junior colleagues and medical
students to distinguish clearly between patient symptoms and physical
signs, e.g. dyspnoea and tachypnoea3, would it not be better to employ the
term ‘alarm feature’ rather than ‘alarm symptom’ when referring to anaemia
in the context of assessment of the patient who has dyspepsia.
Alastair D Smith
consultant physician and gastroenterologist
Department of Medicine,
Eastbourne District General Hospital,
Kings Drive,
Eastbourne
BN21 2UD
1. Logan RFA, Delaney BC. ABC of the gastrointestinal tract:
Implications of dyspepsia for the NHS. BMJ 2001; 323: 675-7. (22
September)
2. Delaney BC. 10-minute consultation: Dyspepsia. BMJ 2001; 322: 776.
3. Crompton GK. The respiratory system. In: Munro JF, Campbell IW, eds.
MacLeod’s Clinical Examination, 10th edition. Edinburgh: Churchill
Livingstone; 2000: 120.
Competing interests: No competing interests