Usefulness of examination of palmar creases for assessing severity of anemia in Indian perspective: A study from a tertiary care center

Abstract

Background and Objectives: Palmar creases may become as pale as the surrounding skin in severe anemia. However, its sensitivity for assessing severe anemia is questionable, especially in Indian perspective. The study was conducted to evaluate the value of palmar creases in detecting severe anemia. Materials and Methods: Patients with laboratory confi rmed anemia were assessed for pallor of palmar creases without information of patient's hemoglobin (Hb) value to the observer. Sensitivity and specifi city of palmar creases pallor were assessed for severe anemia. Role of clinical signs such as severe pallor of conjunctiva, tongue and nail-beds and pulmonary ejection systolic murmur were also assessed for predicting severe anemia. Results: Of 200 patients, 50 had severe anemia (Hb <7 g/dL). Only six patients with Hb <7 g/dL were found to have creases looking similar pale to surrounding skin. Average Hb level of them was 4.05 ± 0.82 g/dL. No patients with Hb ≥7 g/dL had pale palmar creases. In severely anemic patients, its sensitivity is only 12%, but specifi city is 100%, and positive likelihood ratio is >1200. Severe pallor of conjunctiva, tongue and nail-beds and pulmonary ejection systolic murmur were more sensitive, but specifi city of them was less for severe anemia. Conclusions: Color of palmar creases is a poorly sensitive indicator of the severe anemia especially in Indians due to the pigmentation of creases. Hence, the absence of palmar crease pallor is not likely to be of use in ruling out severe anemia.

Hemoglobin screening using cloud based mobile photography applications [Online First]

“…This process could not be automated. [6] and [23] used the proposed method to systematically verify the consistency of palmar creases or tongue analysis and HCS and evaluated pallor to identify a consistent detection method. The findings were promising, as tests resulted in high confidence values (> 80 %).…”

“…As the findings of both [6] and [23] were promising, the use of photography provided an efficient way of eliminating the human eye association factor from both invasive and noninvasive methods used at the time and prevented long exposure times to light sources that could contribute to stress for both patients and practitioners.…”

“…Most of the causes attributed to anemia mortality involve the population's lack of knowledge of how to identify early symptoms as well as a lack of physical home diagnostic tests, and global organizational efforts have had little success in providing medical resources and coverage to specific areas [4]. As technology has spread even faster than has medical coverage [6], this paper aims to develop a mobile application to act as a physical prevention and diagnosis tool for high-confidence hemoglobin estimation, while it is not expected to replace conventional laboratory testing any time soon, it has the advantage of performing a noninvasive analysis, which is very useful in cases of shortage of medical resources.…”