Fingernail hemorrhage

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Alternative names
Splinter hemorrhages

Definition
Splinter hemorrhages are small areas of bleeding or hemorrhage under fingernails or toenails. They take the shape of straight lines and may be caused by microembolic damage to the vessels.

Considerations
Splinter hemorrhages appear as narrow red to reddish brown hemorrhages beneath the nails. They run in the direction of nail growth and are named splinter hemorrhage because they have the appearance of a splinter beneath the fingernail. The hemorrhages may be caused by microscopic clots that damage the small capillaries under the nails.

Splinter hemorrhages are associated with endocarditis and may represent vessel damage from inflammation of the blood vessels (vasculitis) or microscopic clots that damage the small capillaries (microemboli).

Common Causes

• Trauma to the nail (most common cause)
  
• Subacute or acute bacterial endocarditis

Home Care
There is no particular care for splinter hemorrhages. Strictly adhere to your health care provider’s instructions for the treatment of endocarditis.

Call your health care provider if

• You notice splinter hemorrhages in the absence of recent trauma to the nail

Note: Splinter hemorrhages generally are a late-appearing symptom in endocarditis. It is probable that other symptoms causing a visit to the health care provider will have appeared before the appearance of splinter hemorrhages.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting splinter hemorrhage in detail may include:

• When did you first notice this?
  
• Have you had trauma to the nail(s) recently?
  
• Do you have a known diagnosis of endocarditis, or has endocarditis been suspected by your health care provider?
  
• What other symptoms are also present, such as shortness of breath, fever, general ill feeling, muscle aches?

Physical examination may include special attention to the heart and blood circulation systems.

Laboratory studies may include:

• CBC
  
• ESR
  
• Blood cultures

In addition, your health care provider may order:

• Chest X-ray
  
• Cardiac ECHO
  
• ECG

After seeing your health care provider:
You may want to add a diagnosis related to splinter hemorrhages to your personal medical record.

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