Technique

• Inspect the conjunctivae and nail beds for pallor and assess for exertional fatigue and dyspnea suggesting anemia.
• Inspect the skin and mucosa for bruising, petechiae, and bleeding, and ask about gum, nose, urinary, and gastrointestinal bleeding.
• Assess for occult gastrointestinal bleeding by asking about stool color and checking where indicated.
• Where immobility or a hypercoagulable state is present, assess for deep vein thrombosis (unilateral swelling, calf tenderness) and pulmonary embolism.
• In immunosuppressed or neutropenic patients, take the temperature and assess for any infection source, treating a single fever as significant.
• For home transfusion, monitor for reaction (fever, chills, dyspnea, rash, back pain) per order.
• Correlate the clinical findings with the most recent hemoglobin, platelet, and white-count trends.
• For active significant bleeding, severe anemia symptoms, or a neutropenic fever, escalate rather than continuing a full exam.