The Turkish Journal of Pediatrics 2007 , Vol 49 , Num 4
The validity of pallor as a clinical sign of anemia in cases with beta-thalassemia
1Units of Social Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
2Pediatric Hematology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey
Yalçın SS, Ünal 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.

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, İhsan Doğramacı 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 µg/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. Keywords : Beta-thalassemia, pallor, anemia

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