Colour Signs in Medicine

Dr (Brig) YD Singh
MBBS, MD (Medicine), FIACM, DIT

Prof & Head, Unit of Medicine

FOM, AIMST University, Malaysia
 Colour Signs in Medicine

• 3 Colour Signs
– Pallor
– Icterus
– Cyanosis
• Best seen in Natural light
– Except Cyanosis (better seen in Fluorescent light)

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 Colour Signs in Medicine: Pallor
• Pallor: Indication of Anaemia usually
– As per WHO: < 13 gm male, < 12 gm Female
– In adults better seen in posterior part (reflecting
part) of palpebral conjunctiva
– In fair skin people one can compare anterior &
posterior part. Normal contrast seen in colours
goes away (usually Hb < 7 gm/ dL)

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 Colour Signs in Medicine: Pallor

• Pallor:
– Anaemia: all causes
– Non anaemia causes
• Reduction of cardiac output (Shock)
– Pallor may also be due to opaque skin
• Hypothyroidism (deposition of mucopolysacharide)
– Reduced Melanin in skin
• Pan-hypopituitarism
• Procedure to look for Pallor
– Pull the lower eyelid down, both eyes, with both
thumbs. Ask patient to look down & focus at the BULGE

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 Colour Signs in Medicine: Pallor
• Pallor: Where & how to look for

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 Colour Signs in Medicine: Pallor
• This patient had 4 gm/ dL HB
• If the palmar creases are lighter in
colour than the surrounding skin
when the hand is hyperextended,
the hemoglobin level is usually <80
g/L (8 g/dL) (Harrison)
– This sign is only for quantification
• NOT for Diagnosis
– Also this is applicable to Fair skin
colour races (Western / Chinese)
– NOT applicable to coloured skin races

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 Colour Signs in Medicine: Cyanosis
• Bluish discolouration of mucus membrane
– Advanced cases certain skin areas may turn blue
• Nose tip, Ear lobule, Fingers, Toes
– Better seen in Florescent light
• 2 Types : Central, Peripheral (Mixed)
– Central cyanosis best detected by inspecting tongue / under the
tongue
• Examination of the tongue differentiates central from peripheral cyanosis
– Haemoglobin is blue in colour
• Oxyhaemoglobin turns red
• Cyanosis becomes evident when absolute conc of
deoxygenated haemoglobin is 5g / dL
– Patients with Polycythaemia will become cyanosed early
• Patients with anaemia will become cyanosed much later
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 Colour Signs in Medicine: Cyanosis
• Cyanosis is obvious when arterial oxygen saturation
falls below 90% in a person with a normal
haemoglobin level.
– Central cyanosis is therefore a sign of severe
hypoxaemia.
• In patients with anaemia, cyanosis does not occur
until even greater levels of arterial desaturation are
reached.
– Absence of obvious cyanosis does not exclude hypoxia.
– Don’t be fooled if the patient’s bed has cheerful pink
curtains
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 Colour Signs in Medicine: Cyanosis
• Central Cyanosis
• Cardiac Causes
– Fallot’s tetrology
– Eisenmenger Complex
• VSD
• PDA
• Presence of clubbing
In cyanosis indicates
Central cyanosis

Differential Cyanosis and differential Clubbing = PDA

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 Colour Signs in Medicine: Cyanosis
• Peripheral Cyanosis
– Hands / feet are usually cold

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 Colour Signs in Medicine: Jaundice
• Yellow discolouration of skin, mucus membrane
– Relatives notice a yellow discoloration before
patient
• When Serum bilirubin level rises to twice the
upper limit of normal (Normal upto 1.2 mg /dL)
bilirubin is deposited in the tissues of the body.
– It then causes yellow discoloration of skin (jaundice)
and discoloration of the sclerae
– Clinically evident when > 2.5 mg /dL
• Better seen in day light
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 Colour Signs in Medicine: Jaundice
• Bilirubin is actually deposited in the vascular
conjunctiva rather than avascular sclerae
– Sclerae (conjunctivae) are rarely affected by other
pigment changes
• In fact, jaundice is only condition causing yellow sclerae
• Other causes of yellow discoloration of the skin,
but where sclerae remain normal
– Carotenaemia (excess eating of carrots / mangoes)
– Acriflavine, fluorescein and picric acid ingestion

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 Colour Signs in Medicine: Jaundice
• Bile & Bilirubin, Both, are formed in Liver
– Bilirubin is carried away in the bile (to Duodenum or stored in
gall bladder)
• Normal total serum bilirubin concentration
– <17 μmol/L (1 mg/dL)
– Up to 30% (5.1 μmol/L) (0.3 mg/dL) of total is direct-
reacting (or conjugated)
• Upto 70% is Indirect (or un-conjugated)
– Jaundice is rarely detectable if the serum Bilirubin
level is < 43 μmol/L (< 2.5 mg/dL

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 Colour Signs in Medicine: Jaundice
• Jaundice = excess production of bilirubin
– Unconjugated (not water soluble)
– Excessive destruction of RBCs
• Termed haemolytic anaemia
• Produce a lemon-yellow scleral discoloration
– Gilbert’s syndrome
• Jaundice = Obstruction of bile flow from liver
• Dark-yellow or orange tint
– Scratch marks may be present
• Itching (pruritus) due to High Bile salts in blood
– Causes: GB/ CBD calculi, Hepatocellular disease
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 Colour Signs in Medicine: Jaundice

• How to look for Icterus ?

– Procedure just opposite of Pallor
– Conjuctiva/ Sclera under upper lid
– Hidden, protected therefore clear white
– Exposed part of eye
• Exposed to pollution / dirt
• Smoke / dust
• Causes “MUDDY Sclera”
• Not suitable for examination

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