Cyanosis is the change of body tissue color to a bluish-purple hue as a result of having decreased amounts of oxygen bound to the hemoglobin in the red blood cells of the capillary bed. Body tissues that reflect cyanosis are usually in locations where the skin is thinner, including the mucous membranes, lips, nail beds, and ear lobes. Some medications containing amiodarone or silver, Mongolian spots, large birth marks, and the consumption of food products with blue or purple dyes can also result in the bluish skin tissue discoloration and may be mistaken for cyanosis.Cyanosis is further classified into central cyanosis vs. peripheral cyanosis. Pathophysiology
The mechanism behind cyanosis is different depending on whether it is central or peripheral. Central cyanosis
Central cyanosis is caused by a decrease in arterial oxygen saturation (SaO2) and begins to show once the concentration of deoxyhemoglobin in the blood reaches a concentration of ≥ 5.0 g/dL (≥ 3.1 mmol/L or oxygen saturation of ≤ 85 %). Causes of central cyanosis are discussed below. Peripheral cyanosis
Peripheral cyanosis happens when there is increased concentration of deoxyhemoglobin on the venous side of the peripheral circulation. In other words, cyanosis is dependent on the concentration of deoxyhemoglobin. Patients with severe anemia may appear normal despite higher than normal concentrations of deoxyhemoglobin. On the other hand, patients with increased amounts of red blood cells (e.g. polycythemia vera) can appear cyanotic even with lower concentrations of deoxyhemoglobin.
Causes
Central cyanosis
Central cyanosis is often due to a circulatory or ventilatory problem that leads to poor blood oxygenation in the lungs. It develops when arterial oxygen saturation drops below 85% or 75%.Acute cyanosis can be a result of asphyxiation or choking and is one of the definite signs that ventilation is being blocked. Central cyanosis may be due to the following causes:

Central nervous system (impairing normal ventilation):Intracranial hemorrhage
Drug overdose (e.g. heroin)
Generalized tonic–clonic seizure (GTCS)
Respiratory system:Pneumonia
Bronchiolitis
Bronchospasm (e.g. asthma)
Pulmonary hypertension
Pulmonary embolism
Hypoventilation
Chronic obstructive pulmonary disease, or COPD (emphysema)
Cardiovascular system:Congenital heart disease (e.g. Tetralogy of Fallot, right to left shunts in heart or great vessels)
Heart failure
Valvular heart disease
Myocardial infarction
Hemoglobinopathies:Methemoglobinemia 
Sulfhemoglobinemia 
Polycythemia
Congenital cyanosis (HbM Boston) arises from a mutation in the α-codon which results in a change of primary sequence, H → Y. Tyrosine stabilises the Fe(III) form (oxyhaemoglobin) creating a permanent T-state of Hb. Others:
High altitude, cyanosis may develop in ascents to altitudes >2400 m.
Hypothermia
Frostbite
Obstructive sleep apnea

Peripheral cyanosis
Peripheral cyanosis is the blue tint in fingers or extremities, due to an inadequate or obstructed circulation. The blood reaching the extremities is not oxygen-rich and when viewed through the skin a combination of factors can lead to the appearance of a blue color. All factors contributing to central cyanosis can also cause peripheral symptoms to appear but peripheral cyanosis can be observed in the absence of heart or lung failures. Small blood vessels may be restricted and can be treated by increasing the normal oxygenation level of the blood.