Pale nose color is one of the symptoms of anemia. Anemia is a pathological condition in which the amount of hemoglobin, red blood cell count and red blood cell pressure volume per unit volume of circulating blood is lower than normal. Physical examination of pale nose color due to anemia: (a) General condition The patient’s development, nutrition, expression, blood pressure and body temperature can provide clues for the diagnosis of anemia. For example, stunted growth in early childhood is commonly associated with hereditary hemolytic anemia. Patients with malignant tumors have poor general condition and are often cachectic. Wasting and edema in the sagging area suggest malnutritional anemia. Increased blood pressure with facial or circumferential edema is seen in renal disease. Apathy, unresponsiveness and facial edema suggest hypothyroidism. Severe anemia may be associated with hypothermia. Hyperthermia is often due to primary disease or co-infection, and is also seen in acute hemolysis. (B) Special signs 1, skin, sclera material and tongue skin, sclera xanthogranuloma is one of the important signs of hemolytic anemia, often light lemon color, acute hemolysis can be darker, neonatal hemolytic anemia xanthogranuloma severe, and neurological symptoms of nuclear xanthogranuloma. Skin bruising spots bruises suggest leukemia, aplastic anemia or bleeding apparently already anemic thrombocytopenic purple epilepsy, etc. Chronic ulcers on the medial or lateral side of the lower limb ankle should be thought of as chronic hemolytic anemia such as hereditary spherocytosis, sickle cell anemia, etc. Spider’s claw and liver palm suggest liver disease. Flattened or sunken fingernails are commonly associated with iron deficiency anemia. Atrophy of the tongue papillae and a pale, smooth tongue are seen in nutritional anemia and megaloblastic anemia and iron deficiency anemia. In megaloblastic anemia, the tongue may be dimensionally red, often accompanied by pain. 2. Facial and skeletal thalassemia major is characterized by thickened skull, elevated forehead, collapsed nose, and edematous eyelids due to the hyperactive bone marrow sampan. Sternal pressure pain suggests leukemia or hemolytic anemia. Pain and pressure pain in multiple bones such as ribs, spine and frontal bone should be considered multiple myeloma, bone metastatic cancer and leukemia. 3. Lymph node and splenomegaly anemia with obvious local or generalized lymph node enlargement often indicates malignant lymphoma, acute or chronic lymphocytic leukemia, malignant histiocytosis, etc. Mild to moderate splenomegaly should be considered as hemolytic anemia, malignant lymphoma, cirrhosis of the liver, and parasitic infection. If the spleen is significantly enlarged, it is often chronic granulocytic leukemia and myelofibrosis. Chronic lymphocytic leukemia is often less pronounced than chronic granulocytic leukemia, and there may be no splenomegaly in the early stages, but there are a few cases with significant splenomegaly as a unique feature. For some diseases, negative signs also have diagnostic significance, such as an anemic patient with complete cytopenia, but if lymph nodes and splenomegaly are found, primary aplastic anemia is no longer considered. (iii) Neurological manifestations of megaloblastic anemia caused by vitamin Bl deficiency may include peripheral neuritis and joint degeneration of the posterior spinal cord bundle and lateral cords, with decreased or absent sensation of touch, position and tremor, and limited mobility.