Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.

Anaemia is a major health burden worldwide. Although the finding of conjunctival pallor on clinical examination is associated with anaemia, inter-observer variability is high, and definitive diagnosis of anaemia requires a blood sample. We aimed to detect anaemia by quantifying conjunctival pallor u...

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Main Authors: Shaun Collings, Oliver Thompson, Evan Hirst, Louise Goossens, Anup George, Robert Weinkove
Format: Article
Language:English
Published: Public Library of Science (PLoS) 2016-01-01
Series:PLoS ONE
Online Access:http://europepmc.org/articles/PMC4829242?pdf=render
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spelling doaj-b1da20dbdb6f494ba416260633a29fd12020-11-25T01:42:56ZengPublic Library of Science (PLoS)PLoS ONE1932-62032016-01-01114e015328610.1371/journal.pone.0153286Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.Shaun CollingsOliver ThompsonEvan HirstLouise GoossensAnup GeorgeRobert WeinkoveAnaemia is a major health burden worldwide. Although the finding of conjunctival pallor on clinical examination is associated with anaemia, inter-observer variability is high, and definitive diagnosis of anaemia requires a blood sample. We aimed to detect anaemia by quantifying conjunctival pallor using digital photographs taken with a consumer camera and a popular smartphone. Our goal was to develop a non-invasive screening test for anaemia.The conjunctivae of haemato-oncology in- and outpatients were photographed in ambient lighting using a digital camera (Panasonic DMC-LX5), and the internal rear-facing camera of a smartphone (Apple iPhone 5S) alongside an in-frame calibration card. Following image calibration, conjunctival erythema index (EI) was calculated and correlated with laboratory-measured haemoglobin concentration. Three clinicians independently evaluated each image for conjunctival pallor.Conjunctival EI was reproducible between images (average coefficient of variation 2.96%). EI of the palpebral conjunctiva correlated more strongly with haemoglobin concentration than that of the forniceal conjunctiva. Using the compact camera, palpebral conjunctival EI had a sensitivity of 93% and 57% and specificity of 78% and 83% for detection of anaemia (haemoglobin < 110 g/L) in training and internal validation sets, respectively. Similar results were found using the iPhone camera, though the EI cut-off value differed. Conjunctival EI analysis compared favourably with clinician assessment, with a higher positive likelihood ratio for prediction of anaemia.Erythema index of the palpebral conjunctiva calculated from images taken with a compact camera or mobile phone correlates with haemoglobin and compares favourably to clinician assessment for prediction of anaemia. If confirmed in further series, this technique may be useful for the non-invasive screening for anaemia.http://europepmc.org/articles/PMC4829242?pdf=render
collection DOAJ
language English
format Article
sources DOAJ
author Shaun Collings
Oliver Thompson
Evan Hirst
Louise Goossens
Anup George
Robert Weinkove
spellingShingle Shaun Collings
Oliver Thompson
Evan Hirst
Louise Goossens
Anup George
Robert Weinkove
Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
PLoS ONE
author_facet Shaun Collings
Oliver Thompson
Evan Hirst
Louise Goossens
Anup George
Robert Weinkove
author_sort Shaun Collings
title Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
title_short Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
title_full Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
title_fullStr Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
title_full_unstemmed Non-Invasive Detection of Anaemia Using Digital Photographs of the Conjunctiva.
title_sort non-invasive detection of anaemia using digital photographs of the conjunctiva.
publisher Public Library of Science (PLoS)
series PLoS ONE
issn 1932-6203
publishDate 2016-01-01
description Anaemia is a major health burden worldwide. Although the finding of conjunctival pallor on clinical examination is associated with anaemia, inter-observer variability is high, and definitive diagnosis of anaemia requires a blood sample. We aimed to detect anaemia by quantifying conjunctival pallor using digital photographs taken with a consumer camera and a popular smartphone. Our goal was to develop a non-invasive screening test for anaemia.The conjunctivae of haemato-oncology in- and outpatients were photographed in ambient lighting using a digital camera (Panasonic DMC-LX5), and the internal rear-facing camera of a smartphone (Apple iPhone 5S) alongside an in-frame calibration card. Following image calibration, conjunctival erythema index (EI) was calculated and correlated with laboratory-measured haemoglobin concentration. Three clinicians independently evaluated each image for conjunctival pallor.Conjunctival EI was reproducible between images (average coefficient of variation 2.96%). EI of the palpebral conjunctiva correlated more strongly with haemoglobin concentration than that of the forniceal conjunctiva. Using the compact camera, palpebral conjunctival EI had a sensitivity of 93% and 57% and specificity of 78% and 83% for detection of anaemia (haemoglobin < 110 g/L) in training and internal validation sets, respectively. Similar results were found using the iPhone camera, though the EI cut-off value differed. Conjunctival EI analysis compared favourably with clinician assessment, with a higher positive likelihood ratio for prediction of anaemia.Erythema index of the palpebral conjunctiva calculated from images taken with a compact camera or mobile phone correlates with haemoglobin and compares favourably to clinician assessment for prediction of anaemia. If confirmed in further series, this technique may be useful for the non-invasive screening for anaemia.
url http://europepmc.org/articles/PMC4829242?pdf=render
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