Pallor

Pallor describes reduced coloring of the skin and/or mucous membranes and is very subjective. How easily pallor is diagnosed varies with skin color and the thickness and vascularity of the subcutaneous tissue. Sometimes it is only a subtle lightening of skin color. It may be very difficult to detect in a dark-skinned person. It may be only apparent by examining the conjuctiva or oral mucous membranes. Anemia of any cause is the most common reason for pallor, but it lacks sensitivity and specificity as an exam finding.

Differential Diagnosis

• Anemia
• Hypoglycemia
• Circulatory failure: Acute reduction in blood
  flow to the skin or mucous membranes
  –Vasovagal event
  –Shock
  –Hypotension
  –Asphyxia (including birth asphyxia)
  –Hypothermia
  –Congenital or acquired heart disease
  –Sepsis (viral or bacterial)
  –Severe dehydration
• Adrenal failure
  –Recent or long-term use of steroids
  –Addison disease
• Malaria
• Hypopituitarism
• Congenital/familial
• Malnutrition (e.g., anorexia nervosa)
• Generalized edema
• Increased thickness of the skin
  –Myxedema
  –Acromegaly
• Ingestion (e.g., diethylene glycol)
• Localized loss of pigment (vitiligo)
• Cystic fibrosis
• Chronic inflammatory condition
  –Juvenile rheumatoid arthritis
  –Inflammatory bowel disease
  –Systemic lupus erythematosus
  –Diabetes mellitus
  –Chronic renal disease
• Lack of sun exposure
• Atopy
• Migraine
• Breath-holding spell
• Infantile spasms
• Intussusception

Workup and Diagnosis

• History
  –Onset, constant or fluctuating
  –Fever and fever pattern, exposure to illness
  –Fatigue, lethargy, cough, generalized aches
  –Dehydration (vomiting, diarrhea, decreased intake)
  –Travel to malaria-endemic regions
  –Heat or cold intolerance, weight gain or loss
  –Symptoms of anemia, jaundice, previous transfusion, ethnic and cultural background
  –Abnormal sweating
  –Familial red blood cell, heart, or thyroid disease
• Physical exam
  –Ill, vital signs, alertness, sensory exam
  –Pupil size, conjunctival pallor
  –Work of breathing, pulse oximetry
  –Murmur, decreased perfusion, gallop (S₃)
  –Palmar pallor, acrocyanosis, bronzed discoloration
  –Patchy depigmentation, tenting or doughy consistency, abnormal skin thickness, lanugo
• Labs/studies
  –CBC with differential and smear
  –Electrolytes (especially glucose)
  –BUN, Cr, albumin, LFT
  –Blood culture and urine culture
  –Thyroid functions and/or cortisol level
  –Specific infection titers, exam for Plasmodium
  –Chest X-ray, ECG, and echocardiogram
  –Toxicology screen

Treatment

• Immediate respiratory and cardiovascular stabilization
• Cardiovascular collapse or hypoglycemia should be treated appropriately
• Suspected sepsis or infection should be promptly treated with broad-spectrum antimicrobial therapy and supportive treatment
• Stress-dose steroid therapy if insufficiency suspected
• Children with acute blood loss may not manifest anemia until the blood has had a chance to equilibrate
  –Any suspected severe blood loss needs to be managed aggressively
• For children who are stable at presentation
  –First ascertain whether pallor is true or relative
  –Most pallor is due to anemia, so treatment should be directed at underlying cause of decreased hemoglobin production and concentration

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Anemia

Read excerpts from these other book chapters related to Anemia:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Anemia

• Back to symptom: Anemia: Introduction (review 810 causes)
• Next Book Extract About Anemia: Anemia (In A Page: Pediatric Signs and Symptoms)
• All Book Extracts: All Online Book Extracts for Anemia

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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• Anemia (In A Page: Pediatric Signs and Symptoms)
• ANEMIA (Differential Diagnosis in Primary Care)
• PALLOR OF THE FACE, NAILS, OR CONJUNCTIVA (Differential Diagnosis in Primary Care)
• WEAKNESS AND FATIGUE, GENERALIZED (Differential Diagnosis in Primary Care)
• Fatigue (Handbook of Signs & Symptoms (Third Edition))

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