Perf Tech Test 10

Question 1

Heparin Directly Activates

Answer 1

platelets, factor XII, complement, neutrophils, monocytes (aka: immune, inflammatory, complement systems)

Question 2

HIT

Answer 2

heparin-induced thrombocytopenia and thrombosis

heparin binds to PF4 and makes IgG antibodies= decrease platelets by 50%

Question 3

On Bypass and quick exposure of blood to ECC

Answer 3

-plasma protein adsorption to ECC surface
-contact activation of blood (coag/complement/cell signaling stimulation-XII, C3, platelets)
-emboli formation 1)surgery (wound debris) 2)blood activation 3) homologous bld (if not filtered) 4) crystalloid solution 5) roller/spallation
-increased interstitial fluid/edema
=====Whole body inflammation and Temp organ dysfunction

Question 4

Inflation Response Spectrum

Answer 4

(varies patient to patient)
1- mild= fever and leukocytosis
2- significant= tachycardia, high CO/O2 consumption/perm, low SVR
3- Organ dysfunction
4- multiple organ dysfunction 
5- death

Question 5

Key Players: 5 Protein Systems

Answer 5

Contact Activation, Intrinsic , Extrinsic Coag, Fibrinolysis, Complement

Question 6

Heparin Directly Effects/Stimulates

Answer 6

platelets, factor XII, complement, neutrophils, monocytes

Question 7

Protein on Tubing Stimulates

Answer 7

platelets, factor XII, complement

Question 8

Contact Activation Stimulates

Answer 8

complement, coagulation

Question 9

Plasma Contact Activations Involves 4 Proteins

Answer 9

factor XII, prekallikrein, HMWK, factor XI

Question 10

Intrinsic Coagulation Initiated by

Answer 10

plasma contact activation with ECC because of Factor XII (along with HMWK and kallikrein)
(inside vessels)

Question 11

Extrinsic Coagulation Initiated by

Answer 11

Tissue Factor exposure- converse IX and X to IXa and Xa

outside vascular

Question 12

Thrombin Actions

Answer 12

produces fibrin, activates platelets, stimulates tPA

fibrinolysis extrinsic: tPA, fibrin/ intrinsic: XIIa, HMWK, kallikrein

Question 13

Complement System

Answer 13

innate system
classical (antigen-antibody complex)
alternative (C3b, terminal pathway feedback, contact, plasmin)
terminal (C3 convertase)
–end product prevent/limit damage from antigen

Question 14

Complement End Products

Answer 14

• opsonization and phagocytosis (C3b, C4b)
• lysis= MAC (C5b, 6-9)
• agglutination= antigens adhere to each other
• neutrolize virus
• chemotaxis (C5a- call neutrophil and macrophages)
• activates mast and basophils (C3a, C4a, C5a)
• inflammation= increase perm/dilation, decrease CO

Question 15

C Factors= anaphylactic

Answer 15

C3a, C4a, C5a (dilates, mast/basophils, inflammation)

Question 16

C Factors= chemotaxis neutrophil, monocytes, endothelial cells

Answer 16

C5a

Question 17

C Factors= opsonization

Answer 17

C3b, C4b

neutrophil and macrophages come eat!

Question 18

Key Players: 5 Cells

Answer 18

platelets, neutrophils, monocytes, lymphocytes, endothelial cell
(please not my little eel)

Question 19

Platelet: early, late activation and response

Answer 19

early activation- EEC contact, heparin, thrombin!
late activation- C5b-9, hypothermia, hemodilution, sheer force, cytokines
response to activation (change in shape)= express GPIIb/IIIa (fibrin), secrete P-selectin receptor (mono and neutrophils)

Question 20

Neutrophils

Answer 20

C5a, kallikrein, XIIa, heparin, MAC

• express MAC and L-selectins (rolling)
• MAJOR role in reperfusion injury

Question 21

Monocyte

Answer 21

C5a, thrombin, bradykinin at wound or injury

- takes longer than neutrophils

Question 22

Lymphocytes response

Answer 22

decrease numbers after CPB= increase chance for infections

Question 23

Endothelial Cell Activates

Answer 23

(C5a, thrombin, cytokines)

-extrinsic coag, vasodilator, fibrinolysis, inflammatory, perm

Question 24

How can we control Blood-Surface interface

Answer 24

1) surface bound heparin
2) surface modifications
3) blood modifications (colloid prime, corticosteroids, TXA, platelets, NO)
4) pump modifications (cent vs roller, mini circuit, ultrafiltration)

Question 25

Surface Modifications (hep vs non hep coated)

Answer 25

Hep= carmela, trillium, bioline (with albumin)

No Hep= x-coating, balance biosurface, soft line (with albumin), phisio