Pale skin or a pale complexion may occur as a manifestation of sideroblastic anemia in affected individuals. Several factors influence an individual's skin color, including the thickness of the skin, the quantity of blood flowing to the skin, and the amount of melanin present in the skin. Anemia may manifest with paleness in not only the skin but also in mucous membranes like the inner eyelids. The color change that occurs in the skin of anemic individuals is due to the way light reflects off of blood with a poor oxygen concentration.
Poorly oxygenated blood appears as a dark red color inside of the body, and light reflects off of it through the skin with a blue or gray appearance. Oxygen-rich blood is a brighter red inside the body, and light reflects off of it through the skin with a healthy pink appearance. Sideroblastic anemia patients do not have enough hemoglobin in their blood to transport adequate amounts of oxygen. This deficiency causes the patient's blood to have a low or poor oxygen concentration, resulting in paleness or a blue hue to the affected individual's skin.