Yalçin S Songül, Unal Selma, Gümrük Fatma, Yurdakök Kadriye
Unit of Social Pediatrics, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey.
Turk J Pediatr. 2007 Oct-Dec;49(4):408-12.
Pallor is deemed useful in the evaluation of patients suspected of anemia, although its perceived presence or absence may be misleading in cases with increased pigmentation with iron, melanin, or bilirubin. The purpose of this study was to determine the validity of pallor in the detection of anemia in children with beta-thalassemia as an iron overload model. Patients with beta-thalassemia A aged 2 to 32 years who were admitted to the Hematology Unit, Department of Pediatrics, Ihsan Doğramaci Children's Hospital, Ankara, Turkey were assessed for the presence of pallor in three anatomic sites (palm, conjunctiva, buccal mucosa) by a trained pediatrician. Overall, 105 observations were done. The mean age of the patients was 14.7 +/- 6.5 years. The mean hemoglobin (Hb) value was 10.0 +/- 1.2 g/dl (range: 5.4-12.6 g/dl). The sensitivities of palmar, buccal and conjunctival pallor for identifying thalassemic children with anemia were 93.2, 80.7 and 90.9%, respectively. Cases with Hb values less than 11 g/dl could be easily detected by conjunctival pallor, independent of serum ferritin levels. However, there were significant associations between the presence of palmar or buccal pallor and the presence of anemia in children with serum ferritin levels lower than 2500 microg/L. Palmar pallor alone had the highest sensitivity and lowest specificity to detect anemia in cases with beta-thalassemia. Conjunctival pallor was more useful than buccal and palmar pallor in cases with high ferritin levels. Further studies are necessary to detect the validity of pallor in different underlying diseases with anemia.
面色苍白被认为有助于评估疑似贫血的患者，尽管在因铁、黑色素或胆红素导致色素沉着增加的情况下，面色苍白的有无可能会产生误导。本研究的目的是确定面色苍白在检测β地中海贫血患儿贫血中的有效性，β地中海贫血作为一种铁过载模型。对土耳其安卡拉伊桑·多格拉马西儿童医院儿科血液科收治的2至32岁的β地中海贫血A患儿，由一名经过培训的儿科医生评估三个解剖部位（手掌、结膜、颊黏膜）有无面色苍白。总共进行了105次观察。患者的平均年龄为14.7±6.5岁。平均血红蛋白（Hb）值为10.0±1.2g/dl（范围：5.4 - 12.6g/dl）。手掌、颊黏膜和结膜苍白对识别贫血的地中海贫血患儿的敏感性分别为93.2%、80.7%和90.9%。Hb值低于11g/dl的病例可通过结膜苍白轻松检测到，与血清铁蛋白水平无关。然而，在血清铁蛋白水平低于2500μg/L的儿童中，手掌或颊黏膜苍白的存在与贫血的存在之间存在显著关联。单独的手掌苍白在检测β地中海贫血病例中的贫血时敏感性最高但特异性最低。在铁蛋白水平高的病例中，结膜苍白比颊黏膜和手掌苍白更有用。有必要进一步研究以检测面色苍白在不同潜在贫血疾病中的有效性。
