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End of Bed Assessment – 16 Reasons Your Patient is Pale

Here’s a list I’ve had for a while but not published: obvious, less obvious, and utterly surprising reasons your alive patient might be pale. References within. Detailed reference list coming soon.

Image above – a person with vitiligo (Source: Adobe Stock)
  1. Shortness of breath (which may also be due to anaemia) –
  2. Distributive, Cardiogenic, Obstructive + Dissociative shocks (Pilbery & Lethbridge, 2016: 247)
    • Including SOB/DIB, PE, pneumothorax, anaphylaxis
  3. Lung disease, leading to central cyanosis (Douglas et al, 2013: 45) including asthma and COPD (exacerbations & chronic)
  4. Acute myocardial infarction –
  5. Heart failure –
  6. Shock, caused by hypotension –
  7. Vasovagal – ‘Facial pallor is often the first sign of an impending vasovagal faint’.>
  8. Shock – hypovolaemia –
  9. Lingual Raynaud Phenomenon – leading to a white tongue, temporarily –
  10. Drugs – Amiodarone can cause a ‘bluish-grey’ skin discoloration (Douglas et al, 2013: 44)
  11. Vitiligo (segmental and non-segmental) due to the lack of melanin, causes ‘pale patches of skin’ (Douglas et al, 2013: 46); non-segmental vitiligo ‘is thought to be an autoimmune condition’ (NHS – Vitiligo)
  12. Albinism (Douglas et al, 2013: 46)

Discoloration of the hands/nails/eyelids:

Photo above demonstrates reynauds (Source: Adobe Stock)

13. White discoloration of nails – 6 of 155 HIV patients in a 1998 study had this, amongst other more prevalent changes of their nails  –

14. Anaemia – ‘pallor of the conjunctiva, palm, nail beds or at any site was associated with a significantly lower hemoglobin concentration’ – From <>

15. Raynaud Phenomenon – leading to white/yellow/purple fingers, temporarily –

Red herring

16. Rigor mortis and liver mortis in an alive patient who was suffering from a dissecting abdominal aorta:

Have I missed any? Add in the comments below —>

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