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