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.

1. Shortness of breath (which may also be due to anaemia) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2996160/
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 – https://patient.info/doctor/acute-myocardial-infarction
5. Heart failure – https://em.osumc.edu/education/journalClub/SignsandSymptomsofHeartFailure.pdf
6. Shock, caused by hypotension – https://www.nhlbi.nih.gov/health-topics/hypotension
7. Vasovagal – ‘Facial pallor is often the first sign of an impending vasovagal faint’. https://academic.oup.com/brain/article/132/10/2630/329792>
8. Shock – hypovolaemia – https://artifactsjournal.missouri.edu/2016/04/hypovolemic-shock-and-fluid-resuscitation/
9. Lingual Raynaud Phenomenon – leading to a white tongue, temporarily – http://www.cmaj.ca/content/188/15/E396
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:

13. White discoloration of nails – 6 of 155 HIV patients in a 1998 study had this, amongst other more prevalent changes of their nails  – https://jamanetwork.com/journals/jamadermatology/fullarticle/189490

14. Anaemia – ‘pallor of the conjunctiva, palm, nail beds or at any site was associated with a significantly lower hemoglobin concentration’ – From <https://academic.oup.com/jn/article/129/9/1675/4721973>

15. Raynaud Phenomenon – leading to white/yellow/purple fingers, temporarily – http://www.cmaj.ca/content/188/15/E396

Red herring

16. Rigor mortis and liver mortis in an alive patient who was suffering from a dissecting abdominal aorta: https://content.sciendo.com/view/journals/sjfs/22/1/article-p11.xml

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