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. 1997 Feb;12(2):102-6.
doi: 10.1046/j.1525-1497.1997.00014.x.

The relation of conjunctival pallor to the presence of anemia

T N Sheth  1 , N K Choudhry, M Bowes, A S Detsky
Affiliations

The relation of conjunctival pallor to the presence of anemia

T N Sheth et al. J Gen Intern Med. 1997 Feb.

Abstract

Objective: To determine the value of conjunctival pallor in ruling in or ruling out the presence of severe anemia (hemoglobin < or = 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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Figures

FIGURE 1
FIGURE 1
Pale conjunctiva. Note that the color of the pale anterior rim and the posterior part of the conjunctiva are the same.
FIGURE 2
FIGURE 2
Normal conjunctiva. Note the full reddness of the anterior rim and its dissimilarity to the posterior aspect of the conjunctiva.
See this image and copyright information in PMC

Comment in

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