Clinical evaluation of pallor in pediatric patients and its correlation with hemoglobin concentration

Abstract

Background: Anemia is common disorder. In resource poor settings, most health providers rely on physical signs to diagnose anemia. The diagnosis and management of anemia mostly depends on clinical assessment of anemia by increased paleness of body. Pallor is explained as increased paleness of the skin and mucous membranes. Aims: To study sensitivity, specificity and predictive value of pallor at nail bed, palm, tongue and palpebral conjunctiva in diagnosing anemia and correlate pallor with hemoglobin. Materials and Method: we had included 300 children aged between 6 months to 5 years out of which 150 having pallor (Cases) and 150 no pallor (Controls) in this study. Four sites palpebral conjunctiva, tongue, nailbed and palms were examined for pallor. Hemoglobin estimation were done by Drabkin’s method in all children. Anemia was defined according to WHO criteria (Hb < 11g/dl). Data was analyzed statistically. Results: Among 150 children with pallor, tongue pallor was identified in maximum (76%), palmar pallor in minimum (60%). Mean hemoglobin in pallor group ranged from 8.64 to 9.31g/dl and 10.91to 11.24 g/dl in no pallor group. Hemoglobin was lowest with tongue pallor (8.62g/dl). Children with pallor group, 108(72%) had anemia and no pallor group 117(78%) had no anemia. Maximum sensitivity and specificity were for tongue pallor (58.8%) and palmar pallor (91.8%) respectively and maximum predictive value was for palmar pallor (88.74%). Conclusion: Clinical pallor was very useful in detecting anemia, also it had more specific than sensitive value. Best predictor site for detecting pallor in diagnosing anemia was palm.