clubbing pathogenesis

megakaryocytes or large fragments of  megakaryocytes bypass pulmonary capillaries (via shunts, or abnormal circulation within a  neoplasm) in which they normally break up into platelets; in the systemic circulation, these  platelet precursors preferentially lodge in the tips of the digits because of the prevailing patterns of  blood flow. Once stuck there, the cells release platelet-derived growth factor and other substances  that increase endothelial permeability and activate fibroblasts and other connective tissue cells.

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