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562 - Perfusion Technology II > Exam 10 - Blood Surface Interactions > Flashcards

Exam 10 - Blood Surface Interactions Flashcards

1
Q

Heparin activates

A
  • platelets
  • factor 12
  • compliment
  • monocytes
  • neutrophils
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2
Q

HIT mechanism

A
  • Heparin binds to PF4 and induces IgG
  • Heparin/PF4/IgG complex activates platelets
  • 40-50% decrease in platelets = HIT
  • platelet decrease AND thrombosis = HITT
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3
Q

Protein adsorption onto ECC

A
  • fast
  • impossible to predict
    Depends on:
  • [protein]
  • surface chemistry
  • electrical properties
  • hydrophobic/hydrophilic ratio
  • receptor site distribution
  • wettability
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4
Q

Contact activation and ECC

A 
- exposes factor 12 / C3 / platelets
Stimulates:
- coagulation cascade
- complement system
- alters cell signaling
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5
Q

Emboli formation and ECC

A
  • most emboli from surgery….not pump
  • plaque debris
  • air emboli
  • blood activation emboli
  • whole blood IF NOT filtered….we need to filter
  • emboli from crystalloid
  • emboli from roller pump
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6
Q

Emboli material

A
  • fibrin
  • fat
  • protein
  • platelet aggregates
  • red cell debris
  • air
  • spallation
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7
Q

ECC and body reactions

A
  • ECC stimulates rxns all over body
  • change in blood composition triggers inflammation
  • inflammation all over body
  • temporary organ dysfunction
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8
Q

Mild inflammatory response

A
  • fever

- leukocytosis

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9
Q

Severe inflammatory response

A
  • tachycardia
  • increase CO
  • decrease PVR
  • increase O2 consumption
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10
Q

5 protein systems

A
  • contact activation system
  • intrinsic coagulation
  • extrinsic coagulation
  • fibrinolysis
  • complement activation
  • C I E F C
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11
Q

CIEFC

A 
Creates an
Imperfect
Excessive
Feuding
Concoction
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12
Q

Heparin effects

A
  • platelets
  • factor 12
  • complements
  • neutrophils
  • monocytes
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13
Q

ECC tubing stimulates

A
  • factor 12
  • compliment
  • platelets
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14
Q

Contact activation stimulates

A
  • coagulation

- complement

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15
Q

Factor 12

A
  • intrinsic pathway
  • adsorbed onto ECC
    • need HMWK and prekallikrein
  • changes shape and becomes XIIa
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16
Q

XIIa

A
  • cleaves prekallikrein to kallikrein (neutrophil agonist)
  • kallikrein cleaves HMWK to bradykinin (vasodilator)
  • cleaves XI to XIa ( intrinsic coagulation cascade)
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17
Q

Intrinsic pathway

A
  • initiated by contact activation

- factor XII

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18
Q

Extrinsic coagulation

A
  • initiated by TF + VII
    • TF can be cell bound (not pericardium) or in plasma
  • TF + VIIa activates 9 and 10
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19
Q

Thrombin actions

A
  • turns fibrinogen into fibrin
  • cross linking
  • activates platelets
  • stimulates t-PA….fibrinolysis
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20
Q

Extrinsic fibrinolysis activation

A
  • t-PA / urokinase / fibrin
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21
Q

Intrinsic fibrinolysis activation

A
  • XIIa / HMWK / kallikrein
22
Q

Complement system

A
  • coats antigens
  • innate
  • primary mechanism antibodies use to kill
23
Q

Classical complement activation

A
  • antigen-antibody complex
24
Q

Alternative complement activation

A
  • starts with C3b (product of classical)
  • continuous
  • positive feedback loop for amplification
25
Q

Terminal complement pathway

A
  • classical and alternative merge at C3 convertase
26
Q

C3b

A
  • opsonization
27
Q

Functions of complement end products

A
  • opsonization (C3b)
  • lysis (MAC)
  • agglutination
  • neutralization
  • chemotaxis (C5a)
  • activation of mast cells / basophils (C3a/C4a/C5a)
  • inflammation
28
Q

Classical activation

A
  • contact of factor 12
  • heparin-protamine complex at end of CPB
  • ischemia reperfusion
  • blood-air interface
29
Q

Alternative activation

A
  • contact with foreign surface
  • activated suction blood
  • ischemia reperfusion
30
Q

Granulocytes

A
  • neutrophils: 60-70% / phagocytosis
  • Eosinophils: 2-4% / antigen-antibody rxns
  • basophils: 1% / histamine and heparin
31
Q

Agranulocytes

A
  • monocytes: become macrophage in tissue

- lymphocytes: specific / B and T

32
Q

Platelets: early activation initiators

A
  • contact w/ ECC
  • heparin
  • circulating thrombin
  • PAF
33
Q

Platelets: late activators

A
  • C5b-C9
  • Plasmin
  • Hypothermia
  • IL- 6
  • Serotonin
  • Epi
34
Q

Platelets response to activation

A
  • get sticky and angry
  • bind to monocytes and neutrophils
  • P selectin: rolling of monocytes/neutrophils…platelets stick together
  • express GPIIb/IIIa and GPIb….lose after CPB
35
Q

Neutrophil activation

A
  • strong and fast
  • agonists: kallikrein / C5a…..also XIIa/heparin/MAC
  • release granules
  • express MAC and selectin receptors
  • ischemia reperfusion injury and inflammation on CPB
36
Q

Monocytes activation

A
  • slow activation
  • agonists: c%a / thrombin / bradykinin
  • at wound and circuit
  • express TF
  • release cytokines / ILs
    • during/post: 6 and 8
    • post: 1, 2, 4, 6 and 8
37
Q

Lymphocyte response

A
  • drops in # post CPB
  • patient susceptible to infection
  • septic shock / endocarditis / infection
38
Q

Endothelial cell response

A
  • activated by: thrombin / C5a / cytokines / TNF
  • synthesize TF to make thrombin (clot and fibrinolysis)
  • t-PA / PAi-1 for fibrinolysis
  • acute inflammatory response
  • edema
39
Q

Non platelet bleeding post CPB

A
  • fibrinolysis
  • heparin excess
  • hypothermia
  • Protamine excess
40
Q

Platelet related bleeding post CPB

A
  • thrombocytopenia
  • aspirin
  • platelet dysfunction
41
Q

Control of blood surface interface on CPB

A
  • good biomaterial tubing
  • prevent blood activation
  • limit blood activation
42
Q

Terumo X Coating

A
  • no heparin
  • less adhesion
  • on all types of material
  • tie-bond everything
  • PMEA
43
Q

Medtronic Carmeda

A
  • gold standard
  • YES heparin
  • less blood loss / less given
  • shorter LOS and ventilator
  • non-leaching
  • reduces blood activation
  • covalent
44
Q

Medtronic Trillium

A
  • Heparin based
  • non-leaching
  • mimics endothelium
  • negative charge
  • covalent
45
Q

Medtronic Balance

A
  • No heparin
  • same as trillium
  • can use on HIT
46
Q

Maquet Bioline

A
  • Heparin
  • Albumin
  • mimics endothelium
47
Q

Maquet Softline

A
  • NO heparin

- mimics endothelium

48
Q

Sorin Phisio

A
  • No heparin
  • phosphorylcholine
  • stable and durable
  • improves platelet preservation
  • decreases blood activation
49
Q

Blood modifications

A
  • corticosteroids
  • colloid prime (albumin…prevents edema)
  • antifibrinolytic agents
    • ACA…Amicar / TA - blocks plasminogen to plasmin
    • Aprotonin - inhibits plasmin directly
  • platelet anesthesia (NO)
  • complement inhibitors
50
Q

Pump mods

A
  • centrifugal pump
  • pulse flow
  • mini circuits
  • off pump
  • ultrafiltration
  • leukodepletion
  • shed blood management

562 - Perfusion Technology II (9 decks)

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