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Haem Exam

The Nails



  • The nails can reveal signs suggestive of haematologic disease. While pallor of the nail bed is a sign of anaemia, koilonychia suggests potential iron deficiency.

Pallor of the Nail Bed

  • Whitening of the nail beds is classically a sign of anaemia, though may also occur in the context of poor peripheral perfusion.
    • Causes of Pallor of the Nail Bed

    • Anaemia
    • Low cardiac output, due to cardiac disease
    • Peripheral shutdown, due to increased sympathetic activity.


    • Look For

    • Spoon-shaped nails.
    • Significance

    • May be an indicator of iron deficiency anaemia.
    • Causes of Koilonychia

    • Chronic iron deficiency
    • Upper GI carcinoma
    • High altitude
    • Trauma
    • Hypothyroidism
    • Systemic lupus erythematosus
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