Pale tongue, a sign of anaemia?

A study of patients in a hospital in India found that a healthy pink tongue could pretty much rule out anaemia, and that checking the tongue worked better than checking the colour of other parts of the body such as fingernails.

What do we know already?

Anaemia means you don’t have enough haemoglobin, the red pigment in blood that carries oxygen around the body. It’s often due to insufficient iron in your diet, or to repeated bleeding. It’s common among women with heavy periods. Lack of haemoglobin can make you very tired, because your body isn’t getting the oxygen it needs. In countries such as the UK, it’s easy to find out whether you’re anaemic.

Your GP can do a quick blood test that will show whether you have sufficient haemoglobin in your blood. But, in developing countries where healthcare workers have fewer resources, diagnosis is often down to a quick physical examination. People with anaemia often look pale, because of the lack of red pigment in their blood. However, this isn’t always obvious, especially if you have dark skin.

Previous studies have shown that traditional ways of looking for anaemia, such as checking the colour of face or fingernails, are fairly unreliable. Researchers in this study took blood from 390 patients, then asked trained observers (who didn’t know the test results) to examine the patients’ fingernails, palms, inner eyelids, and tongues, to see which site gave the most accurate results for anaemia.

What does the new study say?

 The tongue was the most reliable site for checking whether someone might have anaemia. The observers classed people as having absent, mild, moderate, or severe pallor (paleness). No one whose tongue was judged to be a healthy colour had a blood test showing severe anaemia. But about half of people with very pale tongues (severe pallor) had severe anaemia.

Although there was a connection between pale palms, inner eyelids, and fingernails and the likelihood of anaemia, the link was not strong enough to be reliable.

Where does the study come from?

The study was done by researchers at a hospital in Maharashtra. It was published by the medical journal, PLoS ONE. It was funded by the Indian Council of Medical Research.

What does this mean for me?

If you think you might be anaemic, it’s best to see your doctor for a blood test. It may be hard for you to judge for yourself whether your tongue is a healthy colour — after all, we don’t look at as many tongues as a doctor does. If you do have anaemia, it can usually be treated with iron tablets, although you may need further tests to find out what is causing the problem.