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Haem Exam




Inspecting the patient's skin for evidence of pallor, plethora or jaundice provide information regarding the presence of anaemia, polycythaemia or haemolysis.


Skin pallor is a sign of anaemia.
General inspection of the patient may provide some clue regarding pallor, though it is more significant to assess pallor of the nail beds, palmar creases and conjunctivae.
  • Causes of Pallor

  • Physiologicaly pale skin
  • Anaemia
  • Chronic disease
  • Low cardiac output, due to cardiac disease
  • Peripheral shutdown, due to increased sympathetic activity


Plethora is a change of appearance in the skin due to increased blood flow.
  • Look For

  • Red discolouration, especially of the face.
  • Causes of Plethora

  • Cushing’s syndrome
  • Polycythaemia rubra vera


In the context of the haematology examination, jaundice may be an indicator of haemolytic anaemia.
  • Look For

  • Yellow discolouration of the skin and mucous membranes, due to deposition of bilirubin.
  • Causes of Jaundice

  • Haemolytic

  • Erythrocyte defects - sickle cell anaemia, thalassaemia, folate deficiency, pernicious anaemia, iron deficiency anaemia, sideroblastic anaemia, spherocytosis, lead poisoning
  • Excessive erythrocyte destruction - haemolytic anaemia, thermal injury, envenomation, DIC, haemodialysis, breast milk jaundice
  • Hepatocellular

  • Dysfunctional uptake - drugs
  • Dysfunctional conjugation - Crigler-Najar, Gilbert’s disease
  • Dysfunctional bilirubin storage / excretion - Dubin-Johnson
  • Hepatocyte damage - cirrhosis, hepatitis, tuberculosis, EBV, CMV, varicella, drug-induced hepatitis, autoimmunity, alpha-1 antitrypsin deficiency, Wilson’s disease
  • Cholestatic

  • Intrahepatic cholestasis - drugs, pregnancy, cystic liver disease, sepsis, total parenteral nutrition, Hodgkin’s disease, biliary cirrhosis, sclerosing cholangitis, liver cancer (primary / metastatic)
  • Extrahepatic cholestasis - cholangitis, cholelithiasis, pancreatitis, tumours (eg. pancreatic), bile duct (stenosis or extrinsic compression)
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