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Haem Exam

The Nails

February 15th, 2021


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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