will be discussing about parallel so what happens is in the areas of the body where superficial vessels are present due to the flow of red oxygenated hemoglobin through these vessels there is a reddish range present in these areas okay so if there is reddish changes present then we consider as normal whereas if this reddish change is decreased or it is absent we consider it as parallel okay so to look for pallor we will look in the areas of superficial vessels that is the anterior rim of the lower palpable conjunctiva we can look it over the tongue we can locate over the nail bed and we can look it up over the palm okay so these are the areas where we can look for the palette now then will be the palette present normally the radiation is present to the flow of the oxygenated hemoglobin through the blood vessel so whenever there is decreased concentration of the oxygenated hemoglobin in that case there will be pallor present for which the main causes anemia so the main cause for peller is anemia the cutoff for anemia is in males it is considered as anemia if the concentration is less than 13 gram percent whereas in the females it is considered as anemia when the concentration is less than 10 12 gram percent okay so if the power is present we usually think of it as anemia and if we are suspecting a case of anemia we should also look for the associated features in the general physical examination to look for the associated cause like we can check the names for cholonica as they can be present in iron deficiency anemia we can look for the hyper pigmentation of the knuckles in case of betrayal deficiency and we can look for the bleeding tendencies as if they are present there might be a bone marrow disorder leading to the anemia but one thing which you should always keep in mind is there can be conditions in which the parlor might be present but the anemia is not present so to understand it is the radius change is present to the fl due to the flow of oxygenated hemoglobin so if there is any obstruction to the blood flow such that the blood cannot pass across the obstruction in that case also there will be decreased oxygenated hemoglobin going through the areas of the superficial vessels okay which can happen in case of a peripheral vascular disease can occur in case of left heart failure or can happen in case of shock so whenever the blood flow is decreased in that case is also less oxygen oxygenated hemoglobin which will be reaching these areas and the para will be present similarly if the blood pressure is decreased in that case also the blood flow will be decreased and again the parallel can be present and the blood pressure can be decreased in cases of addiction disease hyperpituitarism and hypothyroidism in addison disease and by hyper pituitarism what happens is the cortisol will decrease and the cortisol increases the release of norepinephrine so if the cortisol is decreased the norepinephrine will be decreased sympathetic activation will be decreased and the blood pressure will decrease similarly the hypoth in hypothyroidism what happens is thyroxine normally increases the sensitivity of catecholamine receptors so if the thyroxine decreases the sensitivity decreases sympathetic activation decreases and thus the blood pressure decreases so there are conditions in which the parlor is present but there is no anemia okay the next thing you need to know is when will be the pallor visible is the pellet visible if the hemoglobin is less than 13 or less than 12 no if the pallor is present on the skin and mucous membranes usually the hemoglobin is level is less than 10 gram percent okay so if the pellet is absent it doesn't always rule out anemia okay as the between the range of 10 to 12 and 10 to 13 the patient might have anemia but the parallel might not be present similarly if you are looking for the parallel of the palm creases you can look in this picture normally what is what happens is the pigmentation over the crease is more than the surrounding area but if the pigmentation over the palm creases becomes less as compared to the surrounding skin we considered it to be severe paler and with a probable level of hemoglobin less than 8 gram percent