Koilonychia in Iron-Deficiency Anemia- A 54-year-old woman presented to the primary care clinic with fatigue and a 7-year history of intermittent hemorrhoidal bleeding. On examination, she appeared pale and had spoon-shaped nails (koilonychia) on the second and third fingers (Panel A) and the thumb (Panel B) of both hands...(see source for labs). Koilonychia is associated with iron-deficiency anemia and may also be hereditary, idiopathic, or associated with nail trauma or solvent exposure. The first three digits may be preferentially affected. The patient was treated with oral iron supplementation... #NEJM #clinical #photo #koilonychia #iron #deficient #anemia #nails