PALLOR PRESENTED BY LAKSHYA BAJAJ MBBSII 4 th

PALLOR PRESENTED BY LAKSHYA BAJAJ MBBS-II (4 th TERM)

Ø INTRODUCTION Ø CAUSES Ø TREATMENT Ø DIAGNOSTIC TESTS Ø DRUG CAUSES Ø DRUG INTERACTIONS

What Is Pallor? Paleness (pallor in Latin) is abnormal loss of color from normal skin or mucous membranes due to reduced amount of Oxyhemoglobin in the skin and the mucous membrane caused by illness, emotional shock or stress, stimulant use, lack of exposure to sunlight, anaemia or genetics. • Pallor is more evident on the face and palms. It can develop suddenly or gradually, depending on the cause. It is not usually clinically significant unless it is accompanied by a general pallor (pale lips, tongue, palms, mouth and other regions with mucous membranes).

CONSIDERATIONS • Unless pale skin is accompanied by pale lips, tongue, palms of the hands, inside of the mouth, and lining of the eyes, it is probably not a serious condition, and does not require treatment. • General paleness affects the entire body, and is most easily seen on the face, lining of the eyes, inner mouth, and nails. Local paleness usually affects a single limb. • Paleness may be very difficult to detect in a dark-skinned person - sometimes it is apparent only in the eye and mouth lining.

NON PATHOLOGICAL CONDITIONS Ø When exposed to low environmental temperature, face, palms or other body parts may become pale because of narrowing (constriction) of the small skin arteries as part of a body’s heat-saving process. Ø When arms or legs above the level of the heart for a minute, they may become pale (and numb or tingling), since the power of the heart can not efficiently pump the blood into the limbs against the force of gravitation. Ø Skipped meal and resulting drop of glucose blood level, or dehydration, may trigger adrenalin release and constriction of your skin arteries. Ø In exertion or fear, blood is redirected from the skin to muscle arteries. Your skin may remain pale for several minutes after exertion.

TYPES : Acute pallor • Sudden paleness Chronic pallor • Long lasting paleness

ACUTE PALLOR Health disorders, causing sudden paleness (within minutes to hours) all over the body: • Dehydration from insufficient drinking, excessive sweating, vomiting, diarrhea • Fainting (vasovagal syncope) due to strong pain, emotions, heat or unpleasant sensations • Migraine Orthostatic hypotension – temporary fall of blood pressure after standing up after prolonged sitting or lying. • Hypothermia • Heart failure due to heart attack, arrhythmia, infective endocarditis or other heart disorder, when the heart can not efficiently pump the blood into the circulation

• Low blood sugar (hypoglycemia), common in insulindependent diabetics after an exercise, skipped meal or insulin overdose • Blood loss due to external or internal bleeding (in car accidents Etc. . ), heavy menstrual bleeding, surgery • Shock - a sudden, deep fall of blood pressure - due to poisoning, severe infection, burns, severe blood loss • Side effect of medications: – warfarin, corticosteroids, aspirin and other antirheumatic drugs may cause intestinal bleeding – iron poisoning • Drug overdose: amphetamine (speed), cocaine • Chemical poisoning (pesticides), plant poisoning (Atropa belladonna) • Death

CHRONIC PALLOR Paleness lasting from few weeks to several years and affecting the whole body may result from: • Low blood pressure, insufficient to keep small skin arteries open • Anemia due to iron or vitamin B 12 and folate deficiency due to • low intake: vegetarians, irregular diet, starvation, alcoholism • impaired absorption: Crohn’s or celiac disease • Intestinal bleeding: colorectal cancer, ulcerative colitis • chronic kidney disease • Chemotherapy • Chronic hepatitis or liver cirrhosis

• Hypertension • Chronic heart failure after heart attack, heart valve disorders, etc. • Side effect of medications: – warfarin, aspirin, ibuprofen, naproxen, corticosteroids may cause intestinal bleeding – iron poisoning • Drug abuse: amphetamine, cocaine • Thrombosis and other blood clotting disorders • Leukemia, lymphoma, Hodgkin disease • Hypopituitarism - impaired production of pituitary hormones, mainly due to pituitary adenoma

DIAGNOSIS To check for anaemia other chronic disorders Chest x-ray ECG rheumatoid factor Other Useful Tests CBC (anemia) Sedimentation rate (chronic infection) Serum B 12 level (pernicious anemia) Serum folic acid level (folic acid deficiency) Serum iron and ferritin levels (iron deficiency anemia) Bone marrow examination (aplastic anemia)

TREATMENT q Anemia is treated with iron supplements or eating of iron rich foods. q Children should also be given vitamins or vitamin-rich foods to help in the absorption of iron in the body. q For severe cases, blood transfusions may be necessary. q Jaundice is treated by eating a liver-friendly diet, taking antihistamines, vitamin B supplements, other medications, and in the case of blockage, surgery may be necessary. q Jaundice in infants is also treated with phototherapy.

Some of the possible treatments for Paleness from various sources may include: o Green leafy vegetables o Ferrous sulphate o Ferrous gluconate o Vitamin C o Folic acid o Vitamin B 12 o Blood transfusion o Corticosteroids o Bone marrow transplantation o Stem cell transplantation