Cyanosis occurs when the blood lacks oxygen causing the skin to appear bluish or purplish. This condition could involve the lips, gums, tongue, nail beds, fingers, toes and mucous membranes. People affected by this could be suffering from some kind of cardiac problem, respiratory disease or even a  blood disorder. The onset of bluish skin discoloration in children or infants can be terribly alarming to parents and so the condition calls for immediate medical evaluation especially when signs of distress are evident.

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People affected by cyanosis are treated based on the underlying medical disorder. Treatment will not only address the problems caused by the underlying disease but prevent permanent damage and life-threatening complications from happening. Without treatment, bluish skin discoloration could mean heart or respiratory failure.

Why does the skin turn blue?

An oxygen-rich blood produces red-pink skin while oxygen-poor blood results in blue-purple skin discoloration. Cyanosis develops due to poorly oxygenated blood. Oxygen is important for healthy cells and tissues and it is transported by hemoglobin. During respiration, oxygen gets into the body through the lungs and the hemoglobin distributes it to the cells and tissues all over the body. Oxygen-poor blood is circulated back to the lungs for replenishment.

There are several reasons behind the bluish discoloration of the skin and this could involve:

  • Lung problems

Respiratory problem permits the flow of oxygen-poor blood without getting the needed oxygen for replenishment. This problem could come in the form of severe pneumonia, COPD, pulmonary hypertension, asthma, bronchitis or inflamed bronchioles. In infants, bluish skin discoloration could be due to hyaline membrane disease – a condition that primarily affects preterm babies.

  • Heart defects or abnormalities

Heart problems may also allow the blood to pass through the lungs without getting oxygen. This could either be due to a blood clot or some form of congenital heart defect.

  • Blood abnormalities

Blood disorders drastically impair oxygen absorption resulting in cyanosis. These disorders could involve excessively high levels of abnormal hemoglobin or Raynaud’s phenomenon – a condition in which the small arteries in the toes and fingers constrict, preventing blood to circulate.

Several other things can also cause the bluish discoloration of the skin, like prolonged seizures, cold exposure and drug overdose. Cyanosis is actually a symptom of an underlying medical issue than a disorder in itself.

When does cyanosis need immediate medical attention?

Bluish skin discoloration should not be ignored because it could be indicative of life-threatening conditions such as cardiopulmonary arrest, congestive heart failure and pulmonary embolism. The first 5 minutes is very crucial for immediate medical intervention and patients should be taken to the nearest hospital if cyanosis is accompanied by:

  • Breathing difficulties
  • Chest pain
  • Shortness of breath
  • Grunting
  • Confusion

Also, parents should never delay bringing their babies to the hospital if the child is also irritable, fussy, difficult to feed and lethargic.

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What are the forms of Cyanosis?

The difference between the two forms of cyanosis has something to do with the part of the body where bluish discoloration is noted. Cyanosis can be peripheral or central.

  • Peripheral

As the name suggests, the bluish discoloration is noted on the peripheral parts like the nail beds, fingers, arms, toes and legs. The extremities receive oxygen-poor blood due to slow blood circulation to the limbs. This could also be attributed to constricted small blood vessels. There is no lung or heart failure involved is this form of cyanosis.

  • Central

This is a serious form of bluish skin discoloration that causes bluish tongue and lips. It may or may not occur with bluish toes and fingers. There might be lung or heart involvement or high level of abnormal hemoglobin.

How is Cyanosis diagnosed?

The doctor will run several tests to determine the cause of the bluish discoloration of the skin. This may involve a series of blood work, X-ray, and echocardiogram. The doctor may also request for cardiac catheterization and monitor the oxygen saturation.

Treatment is primarily targeted towards replenishing the lacking oxygen in the blood. The underlying cause will also be treated. Tissues will eventually die if there is a lack of oxygen in the blood. Treatment may involve:

  • Warming

Warming could be all that is needed to treat bluish fingernails and toes as this will promote blood circulation to the extremities.

  • Oxygenation

Oxygenation is done in combination with other strategies to increase the amount of oxygen in the blood, such as the use of breathing machine, ventilator, medication and substances that contain oxygen.

  • Surgery

This is commonly done in patients with congenital heart defects. Babies born with congenital heart defects are placed on breathing machines to support breathing. Surgery could be done immediately after birth or months or a few years after.

Babies born with heart problems must receive up-to-date immunizations and monitored by the doctor regularly. Older patients may require permanent pacemaker to normalize the heart rate. People suffering from heart problems may also need diuretics and medicines to cause the heart to pump harder. Respiratory infections are also treated using antibiotics.


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