Getaneh T, Girma T, Belachew T, Teklemariam S
Department of Pediatrics and Child Health, Jimma Institute of Health Sciences, Jimma.
Ethiop Med J. 2000 Apr;38(2):77-84.
The diagnosis and management of anemia, which affects a significant proportion of young children in developing countries, largely depends on the clinical assessment for pallor. This study was conducted with the aim of evaluating the utility of pallor in detecting anemia. Children aged 2 to 60 months who visited the pediatric outpatient department of Jimma Hospital over 3 months period were assessed for the presence and degree of pallor in 4 anatomic sites (conjunctivae, tongue and buccal mucosa, nailbeds, palm) by trained nurses. Hemoglobin was then determined using the HemoCue method. Individuals involved in clinical examination did not have access to the laboratory results before documenting their findings. The mean hemoglobin in the 574 children examined was 11.03 gm/dl, and about 46% had anemia. Children younger than 2 years were found to have a higher prevalence of anemia as compared to older children (p < 0.001). Palmar pallor, with a sensitivity of 58%, had the highest sensitivity to detect moderate anemia as compared to other anatomic sites. The presence of either palmar or conjunctival pallor increased the sensitivity to 73%. The inter-observer agreement was highest for conjunctival pallor (kappa value = 0.81). The findings of the study suggest that pallor of a single anatomic site does not have adequate sensitivity to detect moderate anemia. We recommend further studies to look at the performance of severe pallor in correctly identifying severe anemia. Furthermore, the magnitude and causes of anemia need to be studied in a community setting.
贫血的诊断与管理在很大程度上依赖于对苍白的临床评估，而贫血影响着发展中国家相当大比例的幼儿。本研究旨在评估苍白在检测贫血方面的效用。在3个月期间到吉马医院儿科门诊就诊的2至60个月大的儿童，由经过培训的护士评估4个解剖部位（结膜、舌和颊黏膜、甲床、手掌）苍白的存在情况和程度。然后使用血红蛋白仪法测定血红蛋白。参与临床检查的人员在记录其检查结果之前无法获取实验室结果。接受检查的574名儿童的平均血红蛋白为11.03克/分升，约46%的儿童患有贫血。与大龄儿童相比，2岁以下儿童的贫血患病率更高（p < 0.001）。甲床苍白检测中度贫血的敏感性最高，为58%，与其他解剖部位相比。甲床或结膜苍白的存在将敏感性提高到73%。观察者间一致性对于结膜苍白最高（kappa值 = 0.81）。研究结果表明，单一解剖部位的苍白对检测中度贫血没有足够的敏感性。我们建议进一步研究重度苍白在正确识别重度贫血方面的表现。此外，需要在社区环境中研究贫血的严重程度和原因。
