Physical examination maneuver

Physical Exam

Pallor Evaluation

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How to Perform

In good lighting, inspect the sites where color reflects the underlying capillaries and skin pigment is thin — the palpebral conjunctiva (gently pull down the lower lid), the nail beds, the palmar creases, and the lips and oral mucosa — and compare the color with the expected appearance.

How to Interpret

Showing 6 of 7 findings

Anemia

Palmar pallor in a child
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Strong
Generalized facial/skin pallor
Rule in
Somewhat helpfulNo CI
Rule out
Not helpfulNo CI
Evidence:Moderate
Nail bed pallor
Rule in
—
Rule out
Minimally helpful
Evidence:Moderate
Pallor of the lips and oral (tongue/buccal) mucosa
Rule in
—
Rule out
Minimally helpful
Evidence:Moderate
Palmar / palmar-crease pallor
Rule in
—
Rule out
Minimally helpful
Evidence:Moderate
Conjunctival pallor
Rule in
Somewhat helpful
Rule out
Minimally helpful
Evidence:Moderate

Related Bedside Tests

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Hand Inspection
Rule in:HHepatopulmonary Syndrome, HHypoxemia, SHCrohn Disease +17 more
Rule out:SHHepatopulmonary Syndrome, SHOsteoarthritis, MHAnemia +17 more
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Blood Pressure
Rule in:VHHypovolemia, VHMortality, VHStructural Brain Lesion +22 more
Rule out:VHCardiac Tamponade, VHHypovolemia, HLow Cardiac Output +22 more
Eye InspectionMembers
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Eye Inspection
Rule in:VHHyperthyroidism, VHStroke, HSerious Eye Disease +18 more
Rule out:HConjunctivitis, SHHypovolemia, MHAnemia +18 more
Heart RateMembers
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Heart Rate
Rule in:SHAtrial Fibrillation, SHDecompensation, SHHypothyroidism +15 more
Rule out:HDecompensation, SHAtrial Fibrillation, SHPostoperative Complication +15 more
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Jugular Venous Pressure
Rule in:VHShock, HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure +14 more
Rule out:HRight Ventricular Infarction, SHElevated Pulmonary Capillary Wedge Pressure, SHPulmonary Hypertension +14 more
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Spleen Palpation
Rule in:VHSplenomegaly, HMalaria, SHCirrhosis +13 more
Rule out:SHMyelofibrosis, MHInfectious Mononucleosis, MHSplenomegaly +13 more

Related Systems / Regions

CardiovascularHead, Eyes, Ears, Nose, ThroatHematologicIntegumentaryUpper Extremities

Related Diagnoses

AnemiaMyocardial Infarction

Related Chief Complaints

Chest PainDizzinessExertional DyspneaFatigueLightheadednessPallorPalpitationsShortness of BreathWeakness

References

  • Chalco JP, Huicho L, Alamo C, Carreazo NY, Bada CA. Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis. BMC Pediatr. 2005 Dec 8;5:46. doi:10.1186/1471-2431-5-46. PMID: 16336667.
  • Kalantri A, Karambelkar M, Joshi R, Kalantri S, Jajoo U. Accuracy and reliability of pallor for detecting anaemia: a hospital-based diagnostic accuracy study. PLoS One. 2010;5(1):e8545. doi:10.1371/journal.pone.0008545. PMID: 20049324.
  • Nardone DA, Roth KM, Mazur DJ, McAfee JH. Usefulness of physical examination in detecting the presence or absence of anemia. Arch Intern Med. 1990;150(1):201-204. PMID: 2297289.
  • Sheth TN, Choudhry NK, Bowes M, Detsky AS. The relation of conjunctival pallor to the presence of anemia. J Gen Intern Med. 1997 Feb;12(2):102-106. doi:10.1046/j.1525-1497.1997.00014.x. PMID: 9051559.
  • Svensson L, Isaksson L, Axelsson C, Nordlander R, Herlitz J. Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome. Coron Artery Dis. 2003;14(3):225-231. PMID: 12702926.
  • Bickley LS, Szilagyi PG, Hoffman RM, Soriano RP. Bates' Guide to Physical Examination and History Taking. 13th ed. Philadelphia, PA: Wolters Kluwer; 2021.
  • Swartz MH. Textbook of Physical Diagnosis: History and Examination. 9th ed. Philadelphia, PA: Elsevier; 2025.

Research last updated September 10, 2026.