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

Authors

  • Divya Krishnan K. Department of Paediatrics, MES Medical College, Perinthalmanna, Kerala http://orcid.org/0000-0002-6540-9865
  • K. Shreedhara Avabratha Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India
  • K. Varadaraj Shenoy Department of Paediatrics, Father Muller Medical College, Mangalore, Karnataka, India
  • Anand K. V. Department of Emergency Medicine, MES Medical College, Perinthalmanna, Kerala, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20205429

Keywords:

Anemia, Etiology, Grades, Pallor, Under five children

Abstract

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. 

 

Author Biography

Divya Krishnan K., Department of Paediatrics, MES Medical College, Perinthalmanna, Kerala

ASSISTANT PROFESSOR

DEPARTMENT OF PAEDIATRICS

References

Thornburg CD. The Anemias. In: Nelson textbook of Pediatrics, 21st e, Kliegman, St. Geme, Blum, Shah, Tasker, Wilson editors. Philadelphia: Elsevier. 2020:2505-9.

Bharati S, Pal M, Bharati P. Prevalence of anaemia among 6- to 59-month-old children in India: the latest picture through the NFHS-4. J Biosoc Sci. 2020;52:97-107.

Yalçin SS, Unal S, Gümrük F, Yurdakök K. The validity of pallor as a clinical sign of anemia in cases with beta-thalassemia. Turk J Pediatr. 2007;49:408-412.

WHO. Hemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011. Available at: http://www.who.int/vmnis/indicators/haemoglobin. Pdf. Accessed on 10 January 2020.

Dos Santos RF, Gonzalez ES, de Albuquerque EC, de Arruda IK, Diniz Ada S, Figueroa JN et al. Prevalence of anemia in under five-year-old children in a children's hospital in Recife, Brazil. Rev Bras Hematol Hemoter. 2011;33:100-4.

Ashokkumar C, Tayade MC, Nigavekar, Singla, Idgampalli N. Distribution of iron deficiency anemia in rural population: Survey based study. Int J of Healthca Biomed Res. 2014;2:105-9.

Nutrition and anemia. In: National Family Health Survey (NFHS – 3) 2005-06; volume 1, chapter 10. p267-74. Available at: http://pdf.usaid.gov/ pdf_docs/PNADK385.pdf. Accessed on 20 June 2020.

Kotecha PV. Nutritional anemia in young children with focus on Asia and India. Ind J Com Med. 2011;36:8-16.

Rocha Dda S, Capanema FD, Pereira Netto M, FranceschiniSdo C, Lamounier JA. Prevalence and risk factors of anemia in children attending daycare centers in Belo Horizonte--MG. Rev Bras Epidemiol. 2012;15:675-84.

Torres MA, Sato K, QueirozSde S. Anemia in children under 2 years in basic health care units in the State of São Paulo, Brazil. Rev Saude Publica. 1994;28:290-4.

Oliveira RS, Diniz Ad Ada S, Benigna MJ, Miranda-Silva SM, Lola MM, Goncalves MC et al. Magnitude, geographic distribution and trends of anemia in preschoolers, Brazil. RevSaude Publica. 2002;36:26-32.

Luby SP, Kazembe PN, Redd SC, Ziba C, Nwanyanwu OC, Hightower AW et al. Using clinical signs to diagnose anemia in African children. Bull World Health Organ. 1995;73:477-82.

Chalco JP, Huicho L, Alamo C, Carreazo NY, Bada CA.Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis. Bio Med Cent Pediatr. 2005;5:46.

Wamae CN, Mwanza J, Makama S. Palmar pallor as an indicator for anthelminthic treatment among III children aged 2-4 years-Western Kenya, 1998. Morbid Mortal Week Rep. 2000;49(13):278-81.

Kalter HD, Burnham G, Kolstad PR, Hossain M, Schillinger JA, Khan NZ et al Evaluation of clinical signs to diagnose anaemia in Uganda and Bangladesh, in areas with and without malaria. Bull World Health Organ. 1997;75:103-11.

Stoltzfus RJ, Edward-Raj A, Dreyfuss ML, Albonico M, Montresor A, DhojThapa M et al. Clinical pallor is useful to detect severe anemia in populations where anemia is prevalent and severe. J Nutr. 1999;129:1675-81.

Vinnemeier CD, Schwarz NG, Sarpong N, Loag W, Acquah S, Nkrumah B et al. Predictive value of fever and palmar pallor for P. falciparum parasitaemia in children from an endemic area. PLoS One. 2012;7:e36678.

Downloads

Published

2020-12-23

Issue

Section

Original Research Articles