Symptoms of anemia include fatigue, weakness, syncope, decreased appetite and occasionally chest pain, shock or congestive heart failure. In severe anemia the heart rate may increase. Decreased blood pressure, often orthostatic may be present. It is critical to determine the cause of the anemia. The quaiac test for occult blood is based on detection of endogenous peroxidase in RBCs.
Vitamin C can cause a false negative result.
Other data from the medical history may help in determining the cause of the anemia. For instance, papillar atrophy of the tongue and angular stomatitis are common in megaloblastic anemia secondary to Vitamin B12 deficiency. Peripheral neuropathy and paresthesias may accompany Vitamin B12 deficiency. History of a malignancy and the record of treatment are important. A review of all medications is also indicated.