Pallor

Question 1

Causes of Pallor

Answer 1

1. Pheripheral vasocontriction - eg. Shock
2. Anaemia from blood loss (Gut, Resp tract); Deficiency state (Fe, Folate and B12); Chronic Haemolysis (immune/ non-immune mediated); Decreased production (pancytopenia)

Question 2

Pallor in examination cases

Answer 2

1. Thalassaemia
2. Spherocytosis
3. Leukaemia
4. Fanconi Anaemia
5. Autoimnmune Haemolysis

Question 3

Examination steps

Answer 3

1. Note Pallor: Conjuctivae, Oral mucosa, Palm and sole and nail bed
2. Demonstrate poor circulation - poor pulse volume; delay capillary refill, Tachycardia
3. General examination to look for:
   a. Evidence of haemolysis - Jaundice, Cooley’s face (frontal bossing, prominent maxilla and protruded incisors, depressed nasal bridge and hyperpigmentation)
   b. Evidence of deficiency - Stomatitis, Glossitis, Gum hypertrophy, Koilonychia, Nail dystrophy associated with evidence of malnorishment
   c. Evidence of pancytopenia - Bruises and Petechiae
   d. Radial anomaly in Fanconi anaemia
   e. Evidence of Chemotherapy - eg. Alopicia
   f. Look for Lymphadenopathy - axilla, groin, neck and elbow
4. Abdominal examination - Injection marks /bruises / Hepatomegaly/ Splenomegaly
5. Precordial examination for Sternal tenderness and HF