The Relation of Conjunctival Pallor to the Presence of Anemia

OBJECTIVE:

To determine the value of conjunctival pallor in ruling in or ruling out the presence of severe anemia (hemoglobin 90 g/L) and to determine the interobserver agreement in assessing this sign.

DESIGN:

Patients were prospectively assessed for pallor by at least one of three observers. All observations were made without information of the patient's hemoglobin value or of another observer's assessment.

SETTING:

Tertiary-care, university-affiliated teaching hospital.

PATIENTS:

Three hundred and two medical and surgical inpatients.

MEASUREMENTS AND MAIN RESULTS:

Likelihood ratios (LRs) calculated for conjunctival pallor present, borderline, and absent were as follows: pallor present, LR 4.49 (95% confidence interval [CI] 1.80, 10.99); pallor borderline, LR 1.80 (95% CI 1.18, 2.62); pallor absent, LR 0.61 (95% CI 0.44, 0.80). Kappa scores of interobserver agreement between paired observers were 0.75 and 0.54.

CONCLUSIONS:

The presence of conjunctival pallor, without other information suggesting anemia, is reason enough to perform a hemoglobin determination. The absence of conjunctival pallor is not likely to be of use in ruling out severe anemia. With well-defined criteria, interobserver agreement is good to very good.

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Correspondence to Allan S. Detsky MD, PhD.

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Sheth, T., Choudhry, N., Bowes, M. et al. The Relation of Conjunctival Pallor to the Presence of Anemia. J GEN INTERN MED 12, 102–106 (1997). https://doi.org/10.1007/s11606-006-5004-x

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  • conjunctival pallor
  • anemia
  • physical diagnosis
  • likelihood ratios