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Splinter hemorrhages

Fingernail hemorrhage

 

Splinter hemorrhages are small areas of bleeding (hemorrhage) under the fingernails or toenails.

Considerations

 

Splinter hemorrhages look like thin, red to reddish-brown lines of blood under the nails. They run in the direction of nail growth.

They are named splinter hemorrhages because they look like a splinter under the fingernail. The hemorrhages may be caused by tiny clots that damage the small capillaries under the nails.

Splinter hemorrhages can occur with infection of the heart valves (endocarditis). They may be caused by vessel damage from swelling of the blood vessels (vasculitis) or tiny clots that damage the small capillaries (microemboli).

 

Causes

 

Causes may include:

  • Bacterial endocarditis
  • Injury to the nail

 

Home Care

 

There is no specific care for splinter hemorrhages. Follow your health care provider's instructions for treating endocarditis.

 

When to Contact a Medical Professional

 

Contact your provider if you notice splinter hemorrhages and you haven't had any recent injury to the nail.

Splinter hemorrhages most often appear late in endocarditis. In most cases, other symptoms will cause you to visit your provider before splinter hemorrhages appear.

 

What to Expect at Your Office Visit

 

Your provider will examine you to look for the cause of splinter hemorrhages. You may be asked questions such as:

  • When did you first notice this?
  • Have you had an injury to the nails recently?
  • Do you have endocarditis, or has your provider suspected that you have endocarditis?
  • What other symptoms do you have, such as shortness of breath, fever, general ill feeling, or muscle aches?

The physical exam may include special attention to the heart and blood circulation systems.

Laboratory studies may include:

  • Blood cultures
  • Complete blood count (CBC)
  • Erythrocyte sedimentation rate (ESR)

In addition, your provider may order:

  • Chest x-ray
  • ECG
  • Echocardiogram

After seeing your provider, you may want to add a diagnosis of splinter hemorrhages to your personal medical record.

 

 

References

Tosti A. Diseases of hair and nails. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 442.

Wright WF, Mackowiak PA. Fever of unknown origin. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 56.

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        Review Date: 8/14/2015

        Reviewed By: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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