Cyanosis- Causes & Mechanisms

A blue/purple discolouration of the skin and

mucous membranes caused by an absolute
increase in the quantity of deoxygenated
haemoglobin in the blood.
The two final common pathways that can
result in enough deoxygenated haemoglobin
to cause cyanosis are:
an increase in venous blood in the area of
cyanosis
a reduction in oxygen saturation (SaO2).
The amount of deoxygenated haemoglobin
needed to cause cyanosis
is 5g/dl. It is important to note that the total amount of haemoglobin influences the level
of oxygen desaturation that needs to occur before cyanosis.

In other words, it is the absolute amount of

deoxygenated haemoglobin that causes cyanosis,
not the relative amount.

Cyanosis: central
A blue/purple discolouration of the tongue, lips and mucous
membranes.
CAUSES

MECHANISM/S OF CENTRAL CYANOSIS:

In central cyanosis, the deoxygenated blood is
leaving the heart. That is, deoxygenated blood is
present in the arterial circulation even before it
reaches the periphery. This is due to low oxygen
saturation and/or abnormal haemoglobin.
Cardiac:
In cardiac causes of central cyanosis, the main issue is the mixing
of venous and arterial blood, leading to decreased oxygen
saturation. For example, in Tetralogy of Fallot, the ventricular
septal defect results in mixing across the ventricles. This means
the blood leaving the left side of the heart already has a lowerthan-normal oxygen saturation.

Respiratory:
A V/Q mismatch or shunting of blood through the lungs, without
adequate oxygenation, will increase the quantity of deoxygenated
haemoglobin that passes out of the lungs, leading to reduced
oxygen saturation.

DIFFRENCE B/W CENTRAL & PERIPHERAL CYANOSIS

Cyanosis: peripheral
Blue discolouration of the extremities, often in the fingers.
CAUSES
Common
Cold exposure
Decreased cardiac output (e.g. CHF)
Raynauds phenomenon
Less common
Arterial and venous obstruction

MECHANISM/S OF PERIPHERAL CYANOSIS

Peripheral cyanosis is caused by the slowing of
blood flow and increased oxygen extraction in the
extremities. When human bodies are exposed to
cold, peripheral vasoconstriction occurs to maintain
warmth. This leads to reduced blood flow to the
periphery and thus effectively more time for oxygen
to be taken out of the blood hence more
deoxygenated blood is present.

PERIPHERAL CYANOSIS

Similarly, in CHF, decreased cardiac output leads to

vasoconstriction (to maintain blood pressure and venous return),
which decreases blood flow to peripheral areas.