Cyanosis pathophysiology: Difference between revisions

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***Low [[cardiac output]]
***Low [[cardiac output]]
***Vasomotor instability
***Vasomotor instability
**Factors can affect the development of [[cyanosis]]:
*Factors can affect the development of [[cyanosis]]:
***[[Hemoglobin]] concentration
**[[Hemoglobin]] concentration
***[[Human skin color|Skin pigmentation]]
**[[Human skin color|Skin pigmentation]]
***Presence of abnormal [[Hemoglobin|hemoglobins]] interfering with [[oxygen]] [[Chemical affinity|affinity]]
**Presence of abnormal [[Hemoglobin|hemoglobins]] interfering with [[oxygen]] [[Chemical affinity|affinity]]
***Lighting conditions
**Lighting conditions





Revision as of 00:12, 9 March 2018

Cyanosis Microchapters

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Differentiating Cyanosis from other Diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]

Overview

Cyanosis is a bluish or purplish discoloration of skin and mucous membranes. Two mechanisms involved in the development of cyanosis, Systemic arterial oxygen desaturation and increased oxygen absorption by tissues. Cyanosis is evident when arterial oxygen desaturation falls below 85% or the concentration of deoxygenated hemoglobin (Hb) is below 5 gm/dl. Several factors can affect the appearance of cyanosis includes skin pigmentation, Hemoglobin (Hb) levels, oxygen affinity to the hemoglobin (Hb).

Pathophysiology

  • Cyanosis is a bluish or purplish discoloration of the skin and mucous membranes.
  • Appearance of cyanosis depends on the absolute amount of deoxygenated hemoglobin(Hb) present in the blood rather than the ratio of reduced hemoglobin (Hb) to oxygenated hemoglobin (Hb).[1][2]
  • Physiologically, arterial hemoglobin desaturation can be caused by following mechanisms in the person who breathes room air at normal altitude:
    • Alveolar hypoventilation
    • Diffusion impairment
    • Mismatch of ventilation and perfusion
    • Right-to-left shunting
    • Inadequate oxygen transport by hemoglobin
  • According to Lundsgaard and Van Slyke (1923), as well as subsequent investigators, cyanosis is evident when the subpapillary capillaries contain from 4 to 6 gm/dl of deoxygenated hemoglobin and oxygenation of hemoglobin or oxygen saturation falls below 85% (normal ABG PaO2 85-100%).[3][4]
  • Cyanosis occurs due to following mechanisms:
    • Systemic arterial oxygen desaturation.[5][6]
      • Reduced arterial oxygenation can result if the amount of oxygen in the alveoli is lowered or if the gradient between the alveolar oxygen and the arterial oxygen is elevated.
    • Increased oxygen extraction by the tissues
  • Central cyanosis:[7]
  • Peripheral cyanosis:[14][15]
    • In peripheral cyanosis, systemic arterial oxygen saturation is normal.
    • Increased oxygen extraction by tissues causes wide systemic arteriovenous oxygen difference and increased deoxygenated blood on the venous side of the capillary beds.
    • The increased oxygen extraction by tissues results from the sluggish movement of blood through the capillary circulation.
    • Causes for reduced blood flow through capillary circulation include:
  • Factors can affect the development of cyanosis:


Genetics, Associated Conditions, Gross Pathology, Microscopic Pathology

For the detailed information of the genetics, associated conditions, gross and microscopic pathological features associated with conditions causing cyanosis, click the links below.

References

  1. Blount SG (May 1971). "Cyanosis: pathophysiology and differential diagnosis". Prog Cardiovasc Dis. 13 (6): 595–605. PMID 4933007.
  2. GERACI JE, WOOD EH (July 1951). "The relationship of the arterial oxygen saturation to cyanosis". Med. Clin. North Am. 1: 1185–1202. PMID 13098533.
  3. Lundsgaard C (September 1919). "STUDIES ON CYANOSIS : I. PRIMARY CAUSES OF CYANOSIS". J. Exp. Med. 30 (3): 259–69. PMC 2126682. PMID 19868357.
  4. Snider HL, Roy TM (October 1988). "Deoxyhaemoglobin concentrations in the detection of central cyanosis". Thorax. 43 (10): 801. PMC 461518. PMID 3206391.
  5. Adeyinka A, Kondamudi NP. PMID 29489181. Missing or empty |title= (help)
  6. Lundsgaard C (September 1919). "STUDIES ON CYANOSIS : II. SECONDARY CAUSES OF CYANOSIS". J. Exp. Med. 30 (3): 271–93. PMC 2126678. PMID 19868358.
  7. Steinhorn RH (September 2008). "Evaluation and management of the cyanotic neonate". Clin Pediatr Emerg Med. 9 (3): 169–175. doi:10.1016/j.cpem.2008.06.006. PMC 2598396. PMID 19727322.
  8. Whelan JF (May 1984). "Methemoglobin as a cause of cyanosis". Can Med Assoc J. 130 (10): 1260. PMC 1483499. PMID 6722683.
  9. Ananthakrishna R, Moorthy N, Rao DP, Nanjappa MC (2015). "An adult with central cyanosis and differential pulmonary vascularity". Ann Pediatr Cardiol. 8 (3): 253–4. doi:10.4103/0974-2069.150701. PMC 4608209. PMID 26556978.
  10. Stadie WC (September 1919). "THE OXYGEN OF THE ARTERIAL AND VENOUS BLOOD IN PNEUMONIA AND ITS RELATION TO CYANOSIS". J. Exp. Med. 30 (3): 215–40. PMC 2126679. PMID 19868355.
  11. Bailliard F, Anderson RH (January 2009). "Tetralogy of Fallot". Orphanet J Rare Dis. 4: 2. doi:10.1186/1750-1172-4-2. PMC 2651859. PMID 19144126.
  12. Martins P, Castela E (October 2008). "Transposition of the great arteries". Orphanet J Rare Dis. 3: 27. doi:10.1186/1750-1172-3-27. PMC 2577629. PMID 18851735.
  13. Jain A, Patel A, Hoppe IC (2016). "Benzocaine-Induced Cyanosis". Eplasty. 16: ic18. PMC 4879862. PMID 27257469.
  14. Baranoski G, Van Leeuwen SR, Chen TF (July 2017). "On the detection of peripheral cyanosis in individuals with distinct levels of cutaneous pigmentation". Conf Proc IEEE Eng Med Biol Soc. 2017: 4260–4264. doi:10.1109/EMBC.2017.8037797. PMID 29060838. Vancouver style error: initials (help)
  15. Das S, Maiti A (November 2013). "Acrocyanosis: an overview". Indian J Dermatol. 58 (6): 417–20. doi:10.4103/0019-5154.119946. PMC 3827510. PMID 24249890.

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