Detecting clinical signs of anaemia from digital images of the palpebral conjunctiva

Giovanni Dimauro, Attilio Guarini, Danilo Caivano, Francesco Girardi, Crescenza Pasciolla, Angela Iacobazzi

Research output: Contribution to journalArticlepeer-review


The potential for visually detectable clinical signs of anaemia and their correlation with the severity of the pathology have supported research on non-invasive prevention methods. Physical examination for a suspected diagnosis of anaemia is a practice performed by a specialist to evaluate the pallor of the exposed tissues. The aim of the research presented herein is to quantify and minimize the subjective nature of the examination of the palpebral conjunctiva, suggesting a method of diagnostic support and autonomous monitoring. Here we describe the methodology and system for extracting key data from the digital image of the conjunctiva, which is also based on analysis of the dominant colour classes. Effective features have been used herein to establish the inclusion of each image in a diagnosis probability class for anaemia. The images of the conjunctiva were taken using a new low cost and easy to use device, designed to optimize the properties of independence from ambient light. The performance of the system was tested either by extracting manually the palpebral conjunctiva from images or by extracting them in a semi-automatic way based on the SLIC Superpixel algorithm. Tests were conducted on images obtained from 102 people. The dataset was unbalanced, since many more samples of healthy people were available, as often happens in the medical field. The SMOTE and ROSE algorithms were evaluated to balance the dataset, and some classification algorithms for assessing the anaemic condition were tested, yielding very good results. Taking a photo of the palpebral conjunctiva can aid the decision whether a blood sample is needed or even whether a patient should inform a physician, considerably reducing the number of candidate subjects for blood sampling. It also could highlight the suspected anaemia, allowing screening for anaemia in a large number of people, even in resource-poor settings.

Original languageEnglish
Article number2932274
Pages (from-to)113488-113498
Number of pages11
JournalIEEE Access
Publication statusPublished - Jan 1 2019


  • Anaemia
  • Conjunctiva
  • Haemoglobin
  • Image analysis
  • Non-invasive medical device

ASJC Scopus subject areas

  • Computer Science(all)
  • Materials Science(all)
  • Engineering(all)


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