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Perf Tech Exam 3 > Topic 13 Part 1 > Flashcards

Topic 13 Part 1 Flashcards

1
Q

Heparin has been given:

No direct inhibition of coagulation: accelerates action of

A

antithrombin

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2
Q

Heparin has been given:

Direct activation of other blood components (5)

A 
platelets
factor XII
complement system
neutrophils
monocytes
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3
Q

Heparin has been given:

Some patients display allergic response to heparin such as

A

heparin-induced thrombocytopenia

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4
Q

Heparin Induced Thrombocytopenia (HIT)
____% of patients receiving heparin
Causes ______

A

2-5%

bleeding

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5
Q

Heparin Induced Thrombocytopenia and Thrombosis (HITT)
_____% of patients receiving heparin
Causes ______

A

0.1-0.2%

thrombosis

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6
Q

HIT and HITT Mechanism:

  1. Heparin binds to _____ and induces formation of ___ antibodies
  2. Heparin/PF4-IgG complex activates ______
    - ______ circulating number of platelets
    - HIT defined as ____% decrease
    - HITT involves ____ AND any evidence of _____
A
  1. Heparin binds to PF4 (platelet factor 4) and induces formation of IgG antibodies
  2. Heparin/PF4-IgG complex activates platelets
    - Decreases circulating number of platelets
    - HIT defined as 40-50% decrease
    - HITT involves decrease AND any evidence of thrombosis
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7
Q

We are on bypass: Quick exposure of whole blood mass to biomaterials of ECC: (4)

A

plasma protein adsorption onto surface of ECC
contact activation of blood
emboli formation
increased interstitial fluid

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8
Q

We are on bypass: emboli formation (5)

A 
surgery
blood activation
homologous blood (if not filtered)
crystalloid solutions
roller pumps
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9
Q

plasma protein adsorption onto surface of ECC:
•very _____
•amount adsorbed depends on ____ & ______
•correlation between physical / chemical properties of biomaterial and activation of blood are made ______ – _____ possible to predict the response

A
  • very quick
  • amount adsorbed depends on [protein] & intrinsic surface activity of biomaterial
  • correlation between physical / chemical properties of biomaterial and activation of blood are made retrospectively – not possible to predict the response
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10
Q 
plasma protein adsorption onto surface of ECC:
•wettability
•\_\_\_\_\_ / \_\_\_\_\_ ratio
•surface \_\_\_ and \_\_\_\_\_
•roughness / \_\_\_\_\_
•subsurface \_\_\_\_\_
•distribution of functional \_\_\_\_\_\_
A
  • wettability
  • hydrophilic / hydrophobic ratio
  • surface chemistry and electrical properties
  • roughness / porosity
  • subsurface features
  • distribution of functional receptor sites
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11
Q

contact activation of blood: stimulates and alters what (3)

A

coagulation cascade stimulation
complement system stimulation
alteration of cell signaling substances

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12
Q

contact activation of blood: exposes receptor sites for (5)

A
  • blood cells
  • plasma proteins
    • factor XII
    • complement protein 3
  • platelets
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13
Q

emboli from surgery= (2)

A
  1. Wound Debris (fibrin, fat, calcium, cellular debris)
  2. Surgical Manipulation
    •plaque debris (arterial cannulation / cross clamping
    •air emboli (cannulation, incomplete deairing)
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14
Q

emboli from blood activation= (5)

A 
Blood Activation and Trauma
•fibrin emboli
•macroaggregates of proteins and lipoproteins
•fat globules
•platelet & leukocyte aggregates
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15
Q

emboli from homologous blood (if not filtered)= (4)

A
  • platelet & leukocyte aggregates
  • fibrin
  • lipid precipitates
  • red cell debris
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16
Q

emboli from crystalloid solutions= (2)

A
  • inorganic debris

* dust

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17
Q

emboli from roller pumps=

A

•spallation

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18
Q

increased interstitial fluid= (2)

A
  • increased capillary permeability

* accumulation proportional to duration of bypass

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19
Q

End Result: Many different reactions between

A

blood constituents AND exposed tissue of wound AND undefined monolayer of proteins (ECC)

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20
Q

End Result: Huge number of reactions changes what (2)

A

changes composition of the blood

changed blood reaches every organ / tissue / cell

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21
Q

End Result: Change in blood composition triggers normal endothelial cells to do what (2)

A
  1. additional blood proteins converted to active enzymes
  2. all blood cells stimulated to expose various receptors, release granule contents and to synthesize new enzymes & chemicals
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22
Q

End Result: Whole body _____ and temporary _____

A

Whole body inflammation and temporary organ dysfunction

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23
Q

Key Players: Five Protein Systems

“Creates an Imperfect Excessive Feuding Concoction”

A 
Contact Activation System
Intrinsic Coagulation
Extrinsic Coagulation
Fibrinolysis
Complement Activation
24
Q

Plasma Contact Activation: Four proteins

A

factor XII
prekallikrein
high-molecular-weight kininogen (HMWK)
factor XI

25
Q

Plasma Contact Activation: Activated by contact with

A

ECC

26
Q

Plasma Contact Activation:
factor XII adsorbed onto foreign surface of ECC
-____ & _____ must be present

A

prekallikrein & HMWK

27
Q

Plasma Contact Activation:
factor XII changes shape producing
-active protease ____ & _____

A

factor XIIa and XIIf

28
Q

Active Protease Factor XIIa: 3 roles

A
  1. Cleaves prekallikrein to kallikrein
  2. Cleaves HMWK to bradykinin
  3. Activates factor XI to XIa
29
Q

When Protease Factor XIIa Cleaves prekallikrein to kallikrein, what the strong and weak agonists?

A

kallikrein strong neutrophil agonist

factor XIIa weak neutrophil agonist

30
Q

When Protease Factor XIIa Cleaves HMWK to bradykinin, what does bradykinin do?

A

bradykinin potent vasodilator

31
Q

When Protease Factor XIIa Activates factor XI to XIa, what does XIa then activate and what must be present

A

factor XIa activates intrinsic coagulation cascade – thrombin production
kallikrein & HMWK must be present

32
Q

Intrinsic Coagulation Cascade is initiated by what (2)

A

Initiated by plasma contact activation

Initiated directly by blood contact with the ECC

33
Q

Extrinsic Coagulation Cascade is initiated by what

A

Initiated by the expression of tissue factor on nonvascular cells

34
Q

Extrinsic Coagulation Cascade has what 2 forms of tissue factor

A

cell bound tissue factor

soluble plasma tissue factor

35
Q

Extrinsic Coagulation Cascade: the tissue factor Binds to and activates

A

VII which then activates factor X and so on

36
Q

Thrombin Actions

  • Production of _____
  • ____ fibrin
  • Activating _____
  • Stimulating the production of ______ activator by endothelial cells
A
  • Production of fibrin from fibrinogen
  • Cross-linking fibrin
  • Activating platelets
  • Stimulating the production of tissue plasminogen activator (t-PA) by endothelial cells
37
Q

Complement System:
(#) proteins – most inactive ______
Classical pathway: Initiated by ______ complexes

A

30+ proteins – most inactive enzyme precursors

Classical pathway: Initiated by antigen-antibody complexes

38
Q

Complement System: Alternative pathway

  • Initiated by ___ (a product of the classical pathway)
  • Initiated by ____ activation on a _____ basis
  • Feedback loop for ______
A
  • Initiated by C3b (a product of the classical pathway)
  • Initiated by spontaneous activation on a continuous basis
  • Feedback loop for amplification
39
Q

Complement System: Terminal Pathway

  • Classical and Alternative merge at the level of ____
  • End products work to prevent / limit damage from _____
A
  • Classical and Alternative merge at the level of C3 convertase production
  • End products work to prevent / limit damage from invading organism or toxin
40
Q

End Product-Membrane Attack Complex:

Works to prevent / limit damage from invading organism or toxin by (7)

A 
opsonization
lysis
agglutination
neutralization of viruses
chemotaxis
activation of mast cells and basophils
inflammation
41
Q

End Product-Membrane Attack Complex: opsonization= (2)

A
  • neutrophils & macrophages activated

* they engulf bacteria to which antigen-antibody complex is attached

42
Q

End Product-Membrane Attack Complex: lysis= (2)

A
  • final product called lytic complex or terminal complement complex
  • creates a pore in the cell membrane of bacteria or other invading organisms that allows the influx of ions and water into the cell
43
Q

End Product-Membrane Attack Complex: agglutination= (2)

A
  • complement products change surface of invading organisms

* organisms adhere to each other

44
Q

End Product-Membrane Attack Complex: neutralization of viruses=

A

•products can attack structures of some viruses and render them non-virulent

45
Q

End Product-Membrane Attack Complex: chemotaxis= (2)

A
  • C5a causes chemotaxis of neutrophils & macrophages

* large number phagocytes migrate to area

46
Q

End Product-Membrane Attack Complex: activation of mast cells and basophils= (3)

A
  • activated by C3a, C4a, & C5a
  • cells release histamine and other substances into local fluids
  • results increased local blood flow & increased leakage of fluid and protein into the tissue
47
Q

End Product-Membrane Attack Complex: inflammation = (3)

A
  • increased capillary permeability
  • altered vasomotor tone
  • impaired cardiac function
48
Q

Both pathways activated by cardiopulmonary bypass- what causes (6)

A 
cellular damage
endothelial and leukocyte activation
histamine release
increased vascular permeability
generalized inflammatory response
platelet activation
49
Q

Classical pathway activation: (4)

A

Surface contact activation of factor XII
Heparin-protamine complexes
Ischemia reperfusion
Blood-air interface

50
Q

Alternative pathway activation: (3)

A

Contact with foreign surface
Activated pericardium and suction blood
Ischemia reperfusion

51
Q

Complement System & CPB: Activated by both pathways but _____ pathway principal pathway during CPB

A

alternate

52
Q

Complement System & CPB: anaphylatoxins with vasoactive properties

A

C3a, C4a, C5a

53
Q

Complement System & CPB: major neutrophil agonist

A

C5a

54
Q

Complement System & CPB: opsonization is from

A

C3b, C4b

55
Q

Complement System & CPB: Terminal complement complex does what

A
  • accelerates thrombin formation via action on prothrombinase complex
  • activates platelets

Perf Tech Exam 3 (4 decks)

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