Cyanosis refers to bluish discoloration of skin, nail beds and mucous membranes.

Normally haemoglobin carries most of the oxygen in blood. This oxygen carrying capacity of haemoglobin in the blood (present in the arteries) is called oxygen saturation.

Once in the tissues the haemoglobin releases the oxygen and comes back darker and deoxygenated in the blood carried by the veins. This darker venous blood travels to the lungs to be reloaded with fresh oxygen from breathing and comes back to the heart only to be pumped out again in the arteries. (1-5)
When is cyanosis seen?

When the deoxygenated haemoglobin in blood reaches between 4 to 6 gm/dl, cyanosis may be seen. This blood is bluish or purple giving the skin and mucous membranes their appearance.

Normally approximately 80-87% oxygen saturation would give rise to clinically apparent cyanosis. However, in cases of anemia where haemoglobin levels are low, lower oxygen saturation may show up as cyanosis.

A haemoglobin level of 6 g/dl for example shows cyanosis only when oxygen saturation has dropped below 60%. (2)
Two types of cyanosis

Cyanosis may be of two major types: central and peripheral. (3)
Central cyanosis

Central cyanosis is caused by diseases of the heart or lungs or by abnormal haemoglobin types like methemoglobin or sulfhemoglobin etc. This is seen commonly as bluish or purple discoloration of tongue and linings of the mouth.

There may be concomitant peripheral cyanosis.

In cases where there is no peripheral cyanosis, fingers and toes are warm to touch. There may be other features like breathlessness, shallow breathing, rapid breathing etc.
Peripheral cyanosis

Peripheral cyanosis results from decreased local blood circulation in the peripheral organs, arms and legs. This is commonly seen if the arterial blood stagnates too long in the limbs and loses most of its oxygen.

Cyanosis shows up as the levels of deoxygenated blood rises in the small blood vessels of the fingers and toes. This may be seen in heart failure, shock (sluggish or slowing of blood circulation with severe loss of blood pressure), exposure to cold temperatures and diseases of blood circulation.

Limbs appear bluish and are usually cold to touch. Peripheral cyanosis is most intense in nail beds. Warming may resolve the cyanosis.



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