Advertisement!
Author Information Pack
Editorial Board
Submit article
Special Issue
Editor's selection process
Join as Reviewer/Editor
List of Reviewer
Indexing Information
Most popular articles
Purchase Single Articles
Archive
Free Online Access
Current Issue
Recommend this journal to your library
Advertiser
Accepted Articles
Search Articles
Email Alerts
FAQ
Contact Us
Pediatrics Education and Research

Volume  2, Issue 4, October - December 2014, Pages 141-144
 

Original Article

Among Children with Anemia does Presence of Hyperpigmentation as Compare to Absence of Accurately Indicate Vitamin B 12 Deficiency?

Amar Taksande, Sheetal Nikose, Krishna Vilhekar

*Professor, Department of Pediatrics, Jawaharlal Nehru Medical College, Sawangi Meghe, Wardha, Maharashtra -442102. **Senior Resident ***Professor, Department of Pediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, Maharashtra

Choose an option to locate / access this Article:
90 days Access
Check if you have access through your login credentials.        PDF      |
|

Open Access: View PDF

DOI:

Abstract

Background: Hyperpigmentation of dorsum of hands and fingers though considered an important diagnostic sign for Megaloblastic Anemia (MA). Objectives: To evaluate the diagnostic accuracy and reliability of hyperpigmentation for detection of Vit. B 12 deficiency among children. Study Design: A cross-sectional diagnostic study. We prospectively enrolled all children ages 2 months to 5 years presenting to inpatient or outpatient Pediatric departments. We identified the child who looks pallor, and did the hemoglobin (Hb.) and mean corpuscular volume (MCV) level. After that we included those patients who had a Hb. < 11 g/dl, and MCV > 100 fl. Study Procedure: Index test: After fulfilling the inclusion criteria, Pediatric nurse and Pediatric resident sequentially examined the knuckles and terminal phalanges of each study patient for hyperpigmentation (Index test) and the interval between the two observer’s examinations ranged between 30minutes. Reference standard: Serum Vit. B 12 level (reference standard) was  performed after the clinical assessments of the children.  Results: A total of 20 patients, in the age group of 2 months to 5 years were enrolled in the study. The children with Vit. B 12   deficiency was best identified by the presence of hyperpigmentation of knuckle as indicated by the high sensitivity (Pediatric resident :94% and Pediatric Nurse 82%) and satisfactory specificity ( Pediatric resident :66% and Pediatric Nurse 33%), compared with hyperpigmentation of terminal phalanges (Pediatric resident: sensitivity (Sn)=52%, Specificity (Sp)=66% & Pediatric Nurse: Sn=29%, Sp=66%).  Thrombocytopenia was detected in only one case (5%). Leucopenia  was detected in 3 cases (15%). Vit. B 12 deficiency was detected in 17 cases (<80 pg/ ml) out of 20 cases. Conclusion: The presence of hyperpigmentation of knuckle in the anemic children can moderately raise the probability of Vit. B 12 deficiency.

Key word: Vitamin B 12 ; Hyperpigmentation; Diagnostic accuracy; Mean corpuscular volume.


Corresponding Author : Amar Taksande