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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

    • 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 health care provider if:

    • You notice splinter hemorrhages and you haven't had any recent injury to the nail

    Note: Splinter hemorrhages usually appear late in endocarditis. Likely other symptoms will cause you to visit your health care provider before splinter hemorrhages appear.

    What to Expect at Your Office Visit

    Your health care provider will examine you to determine the cause of splinter hemorrhages. The health care provider may ask you the following medical history questions:

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

    Physical examination 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 health care provider may order:

    • Chest x-ray
    • ECG
    • Echocardiogram

    After seeing your health care 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, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 450.

    Mackowiak PA, Durack DT. Fever of unknown origin. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 51.

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          Review Date: 8/19/2013

          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. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

          The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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          St. Luke's Hospital - 232 South Woods Mill Road - Chesterfield, MO 63017 Main Number: 314-434-1500 Emergency Dept: 314-205-6990 Patient Billing: 888-924-9200
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