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"Cyanotic" redirects here. For the band, see Cyanotic (band).

Cyanosis of the hand in someone with low

oxygen saturations
Classification and external resources

Pulmonology, cardiology









Patient UK




[edit on Wikidata]
Cyanosis is the appearance of a blue or purple coloration of the skin or mucous
membranes due to the tissues near the skin surface having low oxygen saturation.
Based on Lundsgaard and Van Slyke's work, [1] it is classically described as occurring
if 5.0 g/dL of deoxyhemoglobin or greater is present.[2] This was based on an
"estimate" of capillary saturation based on a mean of arterial versus peripheral
venous blood gas measurements. [3] Since estimation of hypoxia is usually now
based either on arterial blood gas measurement or pulse oximetry, this is probably
an overestimate, with evidence that levels of 2.0 g/dL of deoxyhemoglobin may
reliably produce cyanosis.[4] Since, however, the presence of cyanosis is dependent
upon there being an absolute quantity of deoxyhemoglobin, the bluish color is more

readily apparent in those with high hemoglobin counts than it is with those
with anemia. Also the bluer color is more difficult to detect on deeply pigmented
skin. When signs of cyanosis first appear, such as on the lips or fingers, intervention
should be made within 35 minutes because a severe hypoxia or severe circulatory
failure may have induced the cyanosis.
The name cyanosis literally means "the blue disease" or "the blue condition". It is
derived from the color cyan, which comes from kyans, the Greek word for "blue".[5]



2.1Central cyanosis

2.2Peripheral cyanosis

2.3Differential cyanosis

3Approach to diagnosis

4See also



A baby with a heart condition. Note purple nailbeds.

Acute arterial thrombosis of the right leg

Cyanosis is defined as a bluish discoloration, especially of the skin and mucous
membranes, due to excessive concentration of deoxyhemoglobin in the blood
caused by deoxygenation.
Cyanosis is divided into two main types: Central (around the core, lips, and tongue)
and Peripheral (only the extremities or fingers).
Central cyanosis[edit]
Central cyanosis is often due to a circulatory or ventilatory problem that leads to
poor blood oxygenation in the lungs. It develops when arterial oxygen saturation
drops to 85% or 75%.
Acute cyanosis can be a result of asphyxiation or choking, and is one of the surest
signs that respiration is being blocked.
Central cyanosis may be due to the following causes:
1. Central nervous system (impairing normal ventilation):

Intracranial hemorrhage

Drug overdose (e.g. heroin)

Tonicclonic seizure (e.g. grand mal seizure)

2. Respiratory system:



Bronchospasm (e.g. asthma)

Pulmonary hypertension

Pulmonary embolism


Chronic obstructive pulmonary disease, or COPD (emphysema)

3. Cardiovascular diseases:

Congenital heart disease (e.g. Tetralogy of Fallot, right to left shunts in heart
or great vessels)

Heart failure

Valvular heart disease

Myocardial infarction

4. Blood:

Methemoglobinemia * Note this causes "spurious" cyanosis, in that, since

methemoglobin appears blue,[6] the patient can appear cyanosed even in the
presence of a normal arterial oxygen level.


Congenital cyanosis (HbM Boston) arises from a mutation in the -codon

which results in a change of primary sequence, H Y. Tyrosine stabilises the
Fe(III) form (oxyhaemoglobin) creating a permanent T-state of Hb.

5. Others:

High altitude, cyanosis may develop in ascents to altitudes >2400 m.


Obstructive sleep apnea

Peripheral cyanosis[edit]
Peripheral cyanosis is the blue tint in fingers or extremities, due to inadequate
circulation. The blood reaching the extremities is not oxygen rich and when viewed
through the skin a combination of factors can lead to the appearance of a blue
color. All factors contributing to central cyanosis can also cause peripheral
symptoms to appear, however peripheral cyanosis can be observed in the absence
of heart or lung failures. Small blood vessels may be restricted and can be treated
by increasing the normal oxygenation level of the blood.
Peripheral cyanosis may be due to the following causes:

All common causes of central cyanosis

Reduced cardiac output (e.g. heart failure, hypovolaemia)

Cold exposure

Arterial obstruction (e.g. peripheral vascular disease, Raynaud phenomenon)

Venous obstruction (e.g. deep vein thrombosis)

Differential cyanosis[edit]

Differential cyanosis is the bluish coloration of the lower but not the upper extremity
and the head. This is seen in patients with a patent ductus arteriosus. Patients with
a large ductus develop progressive pulmonary vascular disease, and pressure
overload of the right ventricle occurs. As soon as pulmonary pressure exceeds aortic
pressure, shunt reversal (right-to-left shunt) occurs. The upper extremity remains
pink because the brachiocephalic trunk, left common carotid trunk and the left
subclavian trunk is given off proximal to the PDA.
Approach to diagnosis[edit]
This article contains instructions, advice, or how-to content. The
purpose of Wikipedia is to present facts, not to train. Please help improve
this article either by rewriting the how-to content or by moving it

to Wikiversity, Wikibooks or Wikivoyage.(May 2016)

Inquire about duration (cyanosis since birth suggests congenital heart
disease) and exposures (drugs or chemicals that result in abnormal

Differentiate central from peripheral cyanosis.

Check for nail clubbing. Combination of clubbing and cyanosis suggests

congenital heart disease and occasionally pulmonary disease.

If cyanosis is localized to an extremity evaluate for peripheral vascular


Evaluate abnormal hemoglobins by hemoglobin electrophoresis,

spectroscopy, and measurement of methemoglobin level. [7]

See also[edit]


Blue baby syndrome

Raynaud's phenomenon

Blue Fugates

1. Jump up^ Lundsgaard C, Van Slyke DD. Cyanosis. Medicine. 2(1):1-76.
2. Jump up^ Mini Oxford Handbook of Clinical Medicine (7th ed.). p. 56.
3. Jump up^ Cyanosis. Lundsgaard C, Van SD, Abbott ME. Cyanosis. Can
Med Assoc J 1923 Aug;13(8):601-4.

4. Jump up^ Goss GA, Hayes JA, Burdon JG. Deoxyhaemoglobin

concentrations in the detection of central cyanosis. Thorax 1988
5. Jump up^ Mosby's Medical, Nursing & Allied Health Dictionary. MosbyYear Book (4th ed.). 1994. p. 425.
6. Jump up^ Methemoglobin
7. Jump up^ Anthony S. Fauci; et al. (2009). Harrison's manual of
medicine (17th ed.). New York: McGraw-Hill
Medical. ISBN 9780071477437.

signs: skin and subcutaneous tissue (R20R23, 782)

signs relating to the respiratory system (R04R07, 786)

ation and history taking


Medical si