Efficacy of site of pallor to detect anemia and its correlation with etiology in under five children

Divya Krishnan K., K. Shreedhara Avabratha, K. Varadaraj Shenoy, Anand K. V.


Background: The diagnosis and management of anemia largely depends on clinical assessment for pallor. Objective was to evaluate the usefulness of clinical pallor to detect anemia, to correlate pallor with grades and etiology of anemia.  

Methods: This case control study included 300 children in the age group of 6months to 5years. Pallor was assessed in four sites conjunctiva, tongue, nailbed and palm. Children with pallor at any one site were taken as study group (n=150) and without pallor at all 4 sites as controls (n=150). Hemoglobin estimation and other relevant investigations were done. Anemia was diagnosed according to WHO criterion (Hb<11 g/dl in 6 months-5 years) and graded as mild, moderate and severe.

Results: Both groups were comparable in characteristics of age and gender (p value>0.05). In pallor group, 119 had anemia, whereas non pallor control group had 45 anemics. Sensitivity and specificity of pallor for anemia detection were 72.6% and 77.2% respectively. Maximum sensitivity, specificity and predictive values were found for palmar pallor. Tongue turned out to be least sensitive for identifying pallor. All the four sites were found to have statistically significant correlation in identifying mild, moderate and severe grades of anemia. Among causes of anemia; iron deficiency anemia was the etiology in 81.1% of cases. Pallor at each site showed no statistically significant correlation with etiology.

Conclusions:Pallor is useful in detecting anemia. Multiple site examination is suggested as its increases the sensitivity. No positive correlation observed between pallor and its etiology. 



Anemia, Etiology, Grades, Pallor, Under five children

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