Date Published: January 1, 2010
Publisher: Public Library of Science
Author(s): Ashwini Kalantri, Mandar Karambelkar, Rajnish Joshi, Shriprakash Kalantri, Ulhas Jajoo, German Malaga. http://doi.org/10.1371/journal.pone.0008545
Abstract: Anaemia is a common disorder. Most health providers in resource poor settings rely on physical signs to diagnose anaemia. We aimed to determine the diagnostic accuracy of pallor for anaemia by using haemoglobin as the reference standard.
Partial Text: Anaemia is a common disorder, affecting a third of the world population most of whom live in resource poor countries . Although diagnosis of anaemia can easily be done by traditional Sahli’s haemoglobinometer, or more recently by electronic cell counters, yet physicians and healthcare workers try to detect anaemia by looking at conjunctival, tongue, palmer, or nailbed pallor . Often physicians use clinical assessment of pallor as a screening test, and order haemoglobin test if one or more sites suggest presence of pallor. This is especially true of crowded outpatients departments of public hospitals, where most doctors either believe that accurate estimation of haemoglobin is either not worth the time and effort needed to obtain it or do not have access to facilities to measure haemoglobin.
We used STARD (Standards for Reporting Diagnostic Accuracy) statement to report this study. Figure 1 shows the sample study profile. In May 2007, a total of 390 patients, 12 years of age and older were enrolled in the study (mean age 40.1 [SD] 17 years, range: 12 to 87 years; 190 [48%] females). Of the 390 patients, 208 were medical inpatients and 182 were outpatients. AK (observer 1) examined a total of 390 patients of whom MP (observer 2) examined 128 patients. The observer 1 could not interpret pallor on six conjunctivae, 27 tongues, 8 palms and 15 nailbeds. We could not measure haemoglobin in 3 patients.
Our main finding is that presence of pallor can modestly raise the probability of severe anaemia while its absence can rule out severe anaemia. Neither presence nor absence of pallor, regardless of its severity, can accurately rule in or rule out moderate anaemia.