title: Conjunctival vasculature in the assessment of anemia.
abstract: OBJECTIVE
  To assess the correlation of the bulbar conjunctival blood column (BCBC) with anemia.
  
  
  METHODS
  A prospective, randomized, masked, two observer case series.
  
  
  METHODS
  Inpatients on hospital wards; outpatients in both the Hematology-Oncology and Ophthalmology Clinics.
  
  
  METHODS
  Observations of the palpebral conjunctival hue (PCH) and BCBC by two observers masked to the patient's diagnosis, laboratory test results, and other's observations. The PCH and BCBC were correlated by slit-lamp examination with serum hemoglobin values. Different threshold levels for anemia were defined as hemoglobin <10, <11, and <12 mg/dl.
  
  
  METHODS
  The parameters included determination of (1) the conjunctival hue, assessed as pink or pale and (2) the bulbar conjunctival blood column, assessed as full (normal), granular, or discontinuous. These data were compared against the patient's hemoglobin level.
  
  
  RESULTS
  Mean hemoglobin was 11.0+/-2.2 mg/dl. Sensitivity of the BCBC and PCH for anemia was 83%-94% and 38%, respectively, regardless of the definition of anemia. Specificity of BCBC improved with increasing hemoglobin threshold levels for anemia: 56% (hemoglobin <10 mg/dl) to 73% (hemoglobin <12 mg/dl); specificity for PCH ranged from 82% to 94%. The BCBC was significantly (P<0.03) associated with anemia for hemoglobin <11 mg/dl for both observers (logistic regression, Spearman correlation). There was a significant (P<0.05) association of PCH with anemia only for hemoglobin <10 mg/dl with logistic regression (one observer only) and with Spearman correlation (both observers).
  
  
  CONCLUSIONS
  The BCBC is significantly associated with anemia, with higher sensitivity and only slightly less specificity than PCH.
authors.affiliation: Storm Eye Institute, Medical University of South Carolina, Charleston 29425-2236, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Kent
authors.forename: S H
authors.initials: SH
authors.lastname: Elsing
authors.forename: R L
authors.initials: RL
authors.lastname: Hebert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000740:Anemia / Q000175:diagnosis*; D001160:Arterioles / Q000473:pathology; D003228:Conjunctiva / Q000098:blood supply*; D004311:Double-Blind Method; D005188:False Negative Reactions; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D006454:Hemoglobins