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Perf Tech Exam 3 > Topic 13 Part 2 > Flashcards

Topic 13 Part 2 Flashcards

(63 cards)

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1
Q

Red Blood Cells (erythrocytes) role is

A

uptake / transport / removal oxygen & carbon dioxide

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2
Q

White Blood Cells (leukocytes): types of Granulocytes

A

neutrophils
eosinophils
basophils

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3
Q

neutrophils: % and role

A

(60 to 70%)

destroy bacteria via phagocytosis

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4
Q

eosinophils: % and role

A

(2 to 4 %)

destroy complex products antigen-antibody reactions

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5
Q

basophils: % and role

A

(.5 to 1%) (release histamine & heparin – vasodilation)

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6
Q

White Blood Cells (leukocytes): types of Agranulocytes

A

monocytes

lymphocytes

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7
Q

monocytes: % and role

A

(3 to 8%)

transform into tissue macrophage

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8
Q

lymphocytes: % and role

A

(20 to 25%)

attach destroy/deactivate bacteria, viruses, other foreign cells – acquired immune response

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9
Q

Platelets (thrombocytes) role

A

coagulation

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10
Q

Key Players: Five Cells

A 
Platelets
Neutrophils
Monocytes
Lymphocytes
Endothelial Cells
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11
Q

Platelets – Initial / Early Activation:

  1. Surface contact with ___
  2. Heparin: increases _____
  3. Circulating thrombin: powerful ____/ probably initial __
  4. ____-activating factor
A
  1. Surface contact with ECC
  2. Heparin: increases sensitivity
  3. Circulating thrombin: powerful agonist/ probably initial activator
  4. Platelet-activating factor (PAF)
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12
Q

Platelets – Late Activation: (7)

A 
Activated Complement (C5b – C9)
Plasmin
Hypothermia
Interleukin-6
Cathepsin G
Serotonin
Epinephrine
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13
Q 
Platelets – Response to Activation:
Immediate shape change
-express \_\_\_\_ pods
-express surface receptors (2)
-secrete receptors from granules: \_\_\_\_
A
  • express pseudo pods
  • express surface receptors: GPIIb/IIIa and GPIb
  • secrete receptors from granules: P-selectin
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14
Q

Platelets – Response to Activation:

____ receptors bind to surface adsorbed fibrinogen – use fibrinogen as bridge to bind to other _____

A

GPIIb/IIIa receptors bind to surface adsorbed fibrinogen – use fibrinogen as bridge to bind to other platelets

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15
Q

Platelets – Response to Activation:

_____ receptors bind to _____ & _____ to form aggregates

A

P-selectin receptors bind to monocytes & neutrophils to form aggregates

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16
Q

Platelets – Response to Activation:

Some platelets break off forming

A

emboli

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17
Q

Platelets – Response to Activation:

Some platelets release a variety of chemicals and proteins (4)

A

thromboxane-A2
platelet factor 4
Beta-thromboglobulin
serotonin

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18
Q

Neutrophil – Very Strong Activation:

Principal agonists

A

kallikrein and C5a

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19
Q

Neutrophil – Very Strong Activation: Other agonists (6)

A 
factor XIIa
heparin
MAC
interleukin 1 Beta
interleukin 8
TNF
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20
Q

Neutrophil – Very Strong Activation: Release contents of granules (9)

A 
lysosomal enzymes
elastase
myeloperoxidase
hydrogen peroxide
hydroxyl radicals
hypochlorous acid
hypobromous acid
acid hydrolases
collagenases
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21
Q

Neutrophil – Very Strong Activation: Express MAC-1 (CD11b/CD18) & CD11c/CD18 receptors which bind to (2)

A
  1. binds to fibrinogen, complement fragment, endothelial cells, collagen
  2. binds with factor X and fibrinogen to facilitate thrombin formation
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22
Q

Neutrophil – Very Strong Activation: Express L-selectin receptor which binds to

A

binds with P-selectin expressed by endothelial cells and platelets

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23
Q

Neutrophil – Very Strong Activation: Major role in

A

ischemia-reperfusion injury & responsible for much of inflammatory response associate with bypass

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24
Q

Monocyte Activation: Slow activation during CPB by (3)

A

C5a
thrombin
bradykinin

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25
Monocyte Activation: - Activated in ___ and ____ - Form conjugates with platelets via ____ and _____ - Delayed increase of tissue factor seen __ hours post CPB
- Activated in wound and circuit - Form conjugates with platelets via GMP-140 and express tissue factor - Delayed increase of tissue factor seen 20 hours post CPB
26
Monocyte Activation: | Produce and release cytokines:
- IL-6 and IL-8 during and post CPB | - IL-1, IL-2, IL-4 post CPB
27
Lymphocyte Response - Number of cells - reduced ____ after bypass - Cell responsiveness to ____ / other agonist is reduced
- Number of cells - reduced first week after bypass | - Cell responsiveness to mitogens / other agonist – reduced
28
Lymphocyte Response | Increases susceptibility of postoperative infections (2)
Septic shock | Endocarditis
29
Endothelial Cell Activation: Activation agents
thrombin, C5a, various cytokines, TNF
30
Endothelial Cell Activation: Cells produce (7)
``` prostacyclin heparan sulfate thrombomodulin protease nexin-1 protein S tissue factor pathway inhibitor t-PA ```
31
Endothelial Cell Activation: Cells produce vasoactive substances like (6)
``` nitric oxide endothelin PAF histamine norepinephrine bradykinin ```
32
Endothelial Cell Activation: Express various receptors (5)
``` tissue factor P-selectin E-selectin ICAM-1 VCAM-1 ```
33
Activated Endothelial Cells: - Synthesize _____ to generate _____ - Initiate _____ - Contribute to the overall acute ______ response - Allow ___ and ____ to enter the interstitial space
- Synthesize tissue factor to generate thrombin - Initiate fibrinolysis - Contribute to the overall acute inflammatory response - Allow fluid and leukocytes to enter the interstitial
34
Hematologic Factors Activated by CPB: Activation Pathway- soluble factors
coagulation cascade complement cascade fibrinolytic system
35
Hematologic Factors Activated by CPB:Activation Pathway- cellular factors
``` platelets neutrophils monocytes lymphocytes endothelial cells ```
36
Hematologic Factors Activated by CPB: Active Mediators Generated- soluble factors
Kallikrein, HMWK, thrombin C3a, C5a, C5b-9 Plasmin
37
Hematologic Factors Activated by CPB:Active Mediators Generated- cellular factors
``` TXA2, serotonin Oxygen radicals, elastase Oxygen radicals, cytokines Cytokines T-PA, cytokines ```
38
Possible Contributions to Bleeding After CPB | Platelet Related Causes (8)
1. Thrombocytopenia 2. Aspirin-induced platelet dysfunction 3. Impaired aggregation response to agonists (epinephrine, collagen, ADP, thrombin 4. Selective loss of youngest (most functional) platelets 5. Platelet fragmentation / loss of membrane receptors 6. Impaired platelet-mediated clot retraction 7. Plasmin-induced platelet activation / dysfunction 8. Platelet activation / dysfunction induced by C5b-9
39
% of Normal Conc Needed for Coagulation: Intrinsic System Only XII Hageman factor
none
40
% of Normal Conc Needed for Coagulation: Intrinsic System Only XI Plasma thromboplastin antecedent
20
41
% of Normal Conc Needed for Coagulation: Intrinsic System Only IX Christmas factor
40
42
% of Normal Conc Needed for Coagulation: Intrinsic System Only VIII Antihemophilic factor A
30
43
% of Normal Conc Needed for Coagulation: Extrinsic System Only VII Proconvertin
25
44
% of Normal Conc Needed for Coagulation: Common Pathway X Stuart factor
40
45
% of Normal Conc Needed for Coagulation: Common Pathway V Proaccelerin, labile factor
40
46
% of Normal Conc Needed for Coagulation: Common Pathway II Prothrombin
40
47
% of Normal Conc Needed for Coagulation: Common Pathway I Fibrinogen
100 mg/dL
48
Control of Blood-Surface Interface: | Develop biomaterial that mimics the endothelial cell layer (2)
surface-bound heparin | surface-modifying additives
49
Control of Blood-Surface Interface: | Prevent or block activation of the blood during bypass=
blood modification
50
Control of Blood-Surface Interface: | Prevent activated blood from reaching your circuit=
Sequestered cardiotomy suction
51
Surface-Bound Heparin is ____ and _____
ionic and covalent
52
Surface-Bound Heparin claims (5)
suppress thrombin formation reduce blood loss & transfusion requirements attenuate inflammatory response depress platelet activation decrease in clinical indicators of morbidity
53
Results of Surface-Bound Heparin: Neither showed much decrease in thrombin formation Mixed results for: (3) No study showed clinical benefits from using a circuit with surface-bound heparin
- post-op bleeding and transfusion requirements - attenuation of complement - decreased activation of neutrophils and monocytes
54
Surface-Modifying Additives for Terumo
X Coating (poly(2-methoxyethylacrylate) (PMEA)-NO heparin)
55
Surface-Modifying Additives for Medtronic (3)
1. Carmeda (HEPARIN coating – covalent bonded) 2. Trillium (HEPARIN coating – covalent bonded) 3. Balance Biosurface (hydrophilic polymer coating-NO heparin)
56
Surface-Modifying Additives for Maquet (2)
1. Bioline (combined albumin and HEPARIN coating ) | 2. Softline (hydrophilic & hydrophobic polymer coating-NO heparin)
57
Surface-Modifying Additives for Sorin
P.h.i.s.i.o (synthetic phosphorylcholine-NO heparin)
58
Blood Modification: | Preop administration of ______ attenuates complement activation
corticosteroids
59
Blood Modification: Antifibrinolytic agents: Aprotinin=
inhibits plasmin directly | high dose partially inhibits kallikrein – platelet sparing
60
Blood Modification: Antifibrinolytic agents: W-aminocarboxylic acids=
inhibit cleavage of plasminogen to plasmin
61
Blood Modification: Antifibrinolytic agents: (4)
Aprotinin W-aminocarboxylic acids Tranexamic acid ε-aminocaproic acid
62
Blood Modification: | Platelet anesthesia= (3)
Reversible inhibition of platelets during procedure Eptifibatide (Integrilin) with or without nitric oxide Nitric oxide provides partial protection
63
Blood Modification: Complement inhibition= (2)
Pexelizumab | TP 10

Perf Tech Exam 3 (4 decks)

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