Has your patient always had blue lips?
We had a similar case with unexplained cyanosis who presented with abdominal pain. The abdominal pain was put aside and co-oximetry and pulse-oximetry both
gave misleading results ( at the time, the co-oximetry results had methemoglobin and Carboxyhemoglobin that were both negative numbers... yet the instrument
seemed in control). Eventually it was determined the patient had a congenital methemoglobinemia (50% met-Hb) with a mutation that generated a slightly different
absorbance spectra that tricked the CO-oximeter into generating negative results. The patient history failed to mention that the patient was bluish since birth and
it was not an acquired symptom.
A nice pair of similar case reports was reported by Mitch Scott & co-authors:
http://www.clinchem.org/content/51/2/434.long
good luck, regards, Andrew
Dr. A. Lyon,
Saskatoon Health Region.
----- Original Message -----
From: Anthea Patterson <[log in to unmask]>
To: [log in to unmask]
Sent: Fri, 28 Nov 2014 07:21:36 -0700 (MST)
Subject: Blue lips
Dear Colleagues
The haematologist have been looking after a 58 year old patient with unexplained cyanosis in the absence of hypoxia or polycythaemia. He has impressively blue lips. As yet we cannot find a cause. Methaemoglobin was not raised. The haematologists were very keen to rule out sulphaemoglobin as he works in a garage with solvents and tyres, but I could not identify a lab that offers it.
Thoughts anyone on getting sulphaemoglobin measured or on the cause of the cyanosis?
Kind regards
Anthea
Anthea Patterson Ph.D. FRCPath
Consultant Biochemist
Dept of Clinical Chemistry
Royal Cornwall Hospital
Treliske
Truro
TR1 3LJ
Tel:01872 252546
[log in to unmask]
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