Chronic anemia is not simply a disease of the blood. Other changes that can occur with long-standing, moderately severe anemia include skin atrophy and koilonychia (spoon-shaped nails, paicularly in iron-deficiency anemia). Fatty change of cardiac myocytes, renal proximal convoluted tubule cells, and centrilobular hepatic cells, and degeneration of neurons of the cerebral coex and basal ganglia are also seen. With time, some of these cells may die, producing a patchy cell loss.Endocarditis usually has an infectious etiology.Fibrinous pericarditis typically is seen following myocardial infarction.Fibrosis of valve leaflets can be seen with aging or as a complication of infective endocarditis. Ref: Linker C.A., Damon L.E., Damon L.E., Andreadis C., Linker C.A. (2013). Chapter 13. Blood Disorders. In M.A. Papadakis, S.J. McPhee, M.W. Rabow (Eds), CURRENT Medical Diagnosis & Treatment 2013.