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Synopsis
Accuracy of clinical pallor to detect anemia among
female patients presenting to outpatient
department of a tertiary care hospital
Proposed By
Dr. Hira Bashir
Postgraduate student of FCPS
(Obstetrics and gynecology)
Under Supervision of
Prof. Shireen Zulifqar Bhutta
FRCOG, FCPS.
Department Of Obstetrics and gynecology. Jinnah
Postgraduate Medical Centre, Karachi
2
The Director,
Research Training and Monitoring Cell,
College of Physicians & Surgeons, Pakistan,
7th Central Street Phase II, DHA, Karachi 75500
Dear Sir,
Please find herewith enclosed copy of synopsis titled Accuracy of clinical pallor
to
detect
anemia among
female
patients
presenting
to
outpatient
department of a tertiary care hospital prepared by Dr. Hira Bashir, as a prerequisite for FCPS-II in Obstetrics and gynecology. RTMC allotted registration number
is OBG-2014-175-13031.
My praiseworthy supervisor is Professor Dr. Shireen Zulifqar Bhutta, FRCOG, FCPS.
Serving as Professor, department of Obstetrics and gynecology, Jinnah Post
Graduate Medical Centre, Karachi.
Yours truly,
(Signature)
Supervisor
3
TO WHOM IT MAY CONCERN
Supervisors signature
4
Prof. Shireen Zulifqar Bhutta
Professor of Obstetrics and gynecology
Jinnah postgraduate medical center, Karachi
Non-Ethical Consideration
This is to certify that the study being conducted by Dr. Hira Bashir titled
Accuracy of clinical pallor to detect anemia among female patients
presenting to outpatient department of a tertiary care hospital has no
ethical issues.
Signature
Introduction:
Anemia is a common disorder, affecting a third of the world population most
of whom live in resource poor countries.1 Anemia is very common in
pregnant patients; one study estimates that 90.1 % pregnant Pakistani
patients are anemic.2
Signs traditionally used in the physical diagnosis of anemia are pallor of the
conjunctivae, nail beds, face, palms, and palmar creases. 3 Of these, only
pallor of the conjunctivae, nail beds, and palms can be used in patients of
any race. Current evidence suggests that conjunctival pallor may be a more
accurate indicator of the presence or absence of anemia than pallor of the
palms or nail beds.4 In addition, conjunctival pallor has been documented to
appear more frequently in patients with severe anemia, and hence may be
more sensitive than other signs.
Although diagnosis of anaemia can easily be done by traditional Sahli's
haemoglobinometer, or more recently by electronic cell counters, yet
physicians and healthcare workers try to detect anaemia by looking at
conjunctival, tongue, palmer, or nailbed pallor. 5 Often physicians use clinical
assessment of pallor as a screening test, and order haemoglobin test if one
or more sites suggest presence of pallor. This is especially true of crowded
outpatients departments of public hospitals, where most doctors either
believe that accurate estimation of haemoglobin is either not worth the time
and effort needed to obtain it or do not have access to facilities to measure
haemoglobin.6 clinical assessment of cunctival palor is useful test for
estimation of anemia. It has sensitivity of 91.3% and specificity of 69.9% .7
There are situations, however, in which the presence of pallor may be more
helpful. For example, clinicians in the office often see patients whose
Operational definitions:
Clinical pallor: will be considered as positive if the color of the anterior rim
of conjunctiva is same as that of the posterior pale rim. Assessed on clinical
examination.
Anemia: anemia will be considered positive if serum Hb < 7mg/dl.
Sensitivity
The ability of conjunctival pallor to detect anemia, positive in patients who
actually have anemia.
Specificity
The ability of conjunctival pallor to identify the patients who do not have
anemia.
Sample Size.
Sample size will be calculated by sensitivity, specificity calculator using
statistics7
Expected sensitivity 91.3%
Expected specificity 69.9%
Confidence interval 95%
Expected prevalence 0.90
Absolute precision required 0.05
Sample size 137
Inclusion Criteria:
OPD.
All having conjunctival pallor on general physical examination,
Exclusion Criteria:
-ve
10
Conjuncti
+ve
TP
FP
-ve
FN
TN
val
pallor
11
References:
1. Kassebaum NJ, GBD 2013 Anemia Collaborators. The Global Burden of
Anemia. Hematol Oncol Clin North Am. 2016 Apr;30(2):247308.
2.Baig-Ansari N, Badruddin SH, Karmaliani R, Harris H, Jehan I, Pasha O, et al.
Anemia prevalence and risk factors in pregnant women in an urban area of
Pakistan. Food Nutr Bull. 2008 Jun;29(2):1329.
3. Collings S, Thompson O, Hirst E, Goossens L, George A, Weinkove R. NonInvasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
PloS One. 2016;11(4):e0153286.
4. Kalantri A, Karambelkar M, Joshi R, Kalantri S, Jajoo U. Accuracy and
reliability of pallor for detecting anaemia: a hospital-based diagnostic
accuracy study. PloS One. 2010;5(1):e8545.
5. Buttarello M. Laboratory diagnosis of anemia: are the old and new red cell
parameters useful in classification and treatment, how? Int J Lab Hematol.
2016 May 16;
6. Sharawy N, Hussein A, Hossny O, Refaa A, Saka A, Mukhtar A, et al. Effects
of haemoglobin levels on the sublingual microcirculation in pregnant women.
Clin Hemorheol Microcirc. 2016 May 30;
7. Butt Z, Ashfaq U, Sherazi SFH, Jan NU, Shahbaz U. Diagnostic accuracy of
pallor for detecting mild and severe anaemia in hospitalized patients. JPMA
J Pak Med Assoc. 2010 Sep;60(9):7625.
12
PERFORMA
Accuracy of clinical pallor to detect anemia among female patients
presenting to outpatient department of a tertiary care hospital
Name_______________
Age_____________________
Reg NO._________________
No___________________
Ph
Address____________________________________________________________
Hb____________________
Gestational age
Parity
Clinical pallor
Anemia
1) nulliparous
1) Yes
1) Yes
2) multiparous
2) No
2) No