THE VALUE OF PALLOR IN
THE IDENTIFICATION OF CHILDREN WITH ANEMIA
Yurdakok K, Güner S, Yalcin
SS
Institute of Child Health, Hacettepe
University, Ankara, TURKEY
Introduction: WHO recommends the evaluation of palmar pallor as
an indication of anemia in IMCI. The purpose of this study was to determine
the validity and inter-observer agreement of pallor in the detection of
anemia in healthy children under 2 years of age.
Methods: Healthy children aged 6 to 24 months (n=141) who
admitted to our Well Baby Clinic were assessed for the presence of pallor
in 3 anatomic sites (palm, conjunctiva, buccal mucosa) by two observers (a
certificated senior pediatrician and a pediatric resident). All
observations were made without information of the children’s hematological
status or of another observer’s assessment. Then blood examination was done
for hemoglobin level. Exclusion criteria included presence of acute or
chronic illness and treatment for anemia during the 3 months preceding the
investigation. Children with hemoglobin level < 11 g/dL were defined as
anemic.
Results: The mean age was 7.9 ± 2.8 mo; 71 (50 %) were boys. A
total of 33 (23.4 %) children had anemia according to blood samples. Palmar
pallor alone had the highest sensitivity to detect anemia. With
multivariate analysis, palmar pallor was significantly associated with
anemia. The inter-observer agreement was highest for pallor of buccal
mucosa (kappa scores = 0.64), lowest for palmar pallor (0.49).
Palm 72-45 75-86 48-50
Buccal
mucosa 18-12 93-96 46-50
Conjunctiva 45-24 86-79 50-42
All 12-12 98-97 67-57
Palm
or conjunctiva 73-46 90-86 48
-50
*The first value is of
senior and the second value is of resident
Conclusion: Therefore this examination is valid only for senior
pediatrician. Palmar pallor is found to be sensitive and spesific but when
only used by senior pediatrician in this study. Conjunctiva and buccal
mucosa pallor has no value.