Physical Exam

Pallor Evaluation

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Video coming September 2026

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

Anemia

Pallor of the lips and oral (tongue/buccal) mucosa

Rule in

—

Rule out

Somewhat helpful

Evidence:Limited

Palmar / palmar-crease pallor

Rule in

—

Rule out

Somewhat helpful

Evidence:Limited

Palmar pallor in a child

Rule in

Somewhat helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Strong

Generalized facial/skin pallor

Rule in

Somewhat helpfulNo CI

Rule out

Not helpfulNo CI

Evidence:Limited

Nail bed pallor

Rule in

—

Rule out

Minimally helpful

Evidence:Limited

Severe Anemia

Conjunctival pallor

Rule in

Somewhat helpfulDerived CI

Rule out

Minimally helpfulDerived CI

Evidence:Limited

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.