PALLOR AS A CLINICAL SIGN OF SEVERE ANEMIA IN CHILDREN - AN INVESTIGATION IN THE GAMBIA

Anaemia associated with malaria is a major public health problem in Af rican countries. Since most primary health facilities have to rely on physical signs and not laboratory tests to detect anaemic patients who need referral for blood transfusion, we have assessed the reliability of simple clinical signs to predict severe anaemia. A trained field a ssistant examined 368 children admitted to a tertiary care hospital, a ssessing the pallor of their eyelids (conjunctiva), palms and nailbeds , counting the respiratory rate and looking for signs of respiratory d istress. After the children's admission, their packed cell volume (PCV ) was measured, and the need for transfusion and the outcomes were not ed. A second observer examined 173 of these children so that interobse rver variability in the detection of clinical signs could be assessed. A total of 27% of the 368 children had a PCV of <15%. In a multiple r egression analysis, definite pallor of the conjunctiva, definite pallo r of the palms, and a ''sick'' appearance of the child were identified as independent significant predictors of a PCV of <15%. The best pred ictor was a combination of definite pallor of the conjunctiva and pall or of the palms, with a sensitivity of 80% and a specificity of 85%. i nclusion of signs of respiratory distress did not improve the predicti on. Pallor was a reproducible sign (weighted kappa statistic for the c omparison between two observers: kappa = 0.6 for conjunctival pallor). We conclude that pallor can be used as a sign for referring children who may require blood transfusion.