One Yellow, One Orange
A part of medical evaluation in the emergency department is assessing what color a person is. I am not talking about race. I am talking about disease processes that make an otherwise normal person turn an abnormal color.
The most common example we see is pallor, or looking pale. This is usually caused by insufficient blood.
We also see people who are blue. Rarely, this is caused by hereditary abnormalities that cause a healthy person to be blue all the time. In the emergency department, we are more interested in acute medical problems that turn a person blue. The most common of these is cyanosis, a blue color brought on by low oxygen levels in the blood. This happens because the blood protein, hemoglobin, is bright red when it is carrying oxygen and blue when it is not. So, if patients are unable to get their blood adequately saturated with oxygen, they turn blue.
Jaundice is an abnormal orange color of the skin and a yellowing of the white part of the eyes. It is often associated with liver or gallbladder problems. Some patients have such bad jaundice they are sometimes, with less than appropriate respect, referred to as pumpkins.
There are other color abnormalities but they are less common and more obscure.
Years ago, I took care of a woman who was dying from cancer that had spread all over her body. The cancer caused extreme liver dysfunction and profound anemia. All we could do was admit her to the hospital to keep her comfortable until she died, which was expected very soon.
This woman was an amazing bright yellow. I was very used to seeing jaundiced patients, but when I first saw her, I was set back. Then, I realized that the “normal” orange appearance of a jaundiced person is caused by two colors: the bright yellow by-products of liver disease and the red coloration from normal blood. This patient was severely anemic and did not have normal red hemoglobin, so her skin color was affected only by the bright yellow jaundice of her failing liver.
This week, I had an orange patient with another interesting story of anemia. She was a middle-aged woman who had been told years ago she had large benign tumors, called fibroids, in her womb. These caused her to have excessive vaginal bleeding and her doctor had recommended a surgical hysterectomy.
The patient did not want to have surgery, so she sought out a natural remedy for her problem. For years, she drank large volumes of carrot juice with the hope it would shrink her fibroid tumors.
She came to our emergency department with severe anemia caused by her persistent bleeding. Like the cancer patient, her abnormal color was amplified by the lack of normal blood color in her skin. But, rather than being abnormally yellow from liver disease, she was bright orange from all of the carrot juice she had consumed. See this interesting Wikipedia article on how this happens: http://en.wikipedia.org/wiki/Carotenosis
This patient was admitted to the hospital for a blood transfusion and the hysterectomy she had tried so hard to avoid.
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