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Perf Tech Exam 3 > Topic 13 Part 2 > Flashcards

Topic 13 Part 2 Flashcards

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
Q

Monocyte Activation:

  • Activated in ___ and ____
  • Form conjugates with platelets via ____ and _____
  • Delayed increase of tissue factor seen __ hours post CPB
A
  • 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
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26
Q

Monocyte Activation:

Produce and release cytokines:

A
  • IL-6 and IL-8 during and post CPB

- IL-1, IL-2, IL-4 post CPB

27
Q

Lymphocyte Response

  • Number of cells - reduced ____ after bypass
  • Cell responsiveness to ____ / other agonist is reduced
A
  • Number of cells - reduced first week after bypass

- Cell responsiveness to mitogens / other agonist – reduced

28
Q

Lymphocyte Response

Increases susceptibility of postoperative infections (2)

A

Septic shock

Endocarditis

29
Q

Endothelial Cell Activation: Activation agents

A

thrombin, C5a, various cytokines, TNF

30
Q

Endothelial Cell Activation: Cells produce (7)

A 
prostacyclin
heparan sulfate
thrombomodulin
protease nexin-1
protein S
tissue factor pathway inhibitor
t-PA
31
Q

Endothelial Cell Activation: Cells produce vasoactive substances like (6)

A 
nitric oxide
endothelin
PAF
histamine
norepinephrine
bradykinin
32
Q

Endothelial Cell Activation: Express various receptors (5)

A 
tissue factor
P-selectin
E-selectin
ICAM-1
VCAM-1
33
Q

Activated Endothelial Cells:

  • Synthesize _____ to generate _____
  • Initiate _____
  • Contribute to the overall acute ______ response
  • Allow ___ and ____ to enter the interstitial space
A
  • Synthesize tissue factor to generate thrombin
  • Initiate fibrinolysis
  • Contribute to the overall acute inflammatory response
  • Allow fluid and leukocytes to enter the interstitial
34
Q

Hematologic Factors Activated by CPB: Activation Pathway- soluble factors

A

coagulation cascade
complement cascade
fibrinolytic system

35
Q

Hematologic Factors Activated by CPB:Activation Pathway- cellular factors

A 
platelets
neutrophils
monocytes
lymphocytes
endothelial cells
36
Q

Hematologic Factors Activated by CPB: Active Mediators Generated- soluble factors

A

Kallikrein, HMWK, thrombin
C3a, C5a, C5b-9
Plasmin

37
Q

Hematologic Factors Activated by CPB:Active Mediators Generated- cellular factors

A 
TXA2, serotonin
Oxygen radicals, elastase
Oxygen radicals, cytokines
Cytokines
T-PA, cytokines
38
Q

Possible Contributions to Bleeding After CPB

Platelet Related Causes (8)

A
  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
Q

% of Normal Conc Needed for Coagulation:
Intrinsic System Only
XII Hageman factor

A

none

40
Q

% of Normal Conc Needed for Coagulation:
Intrinsic System Only
XI Plasma thromboplastin antecedent

A

20

41
Q

% of Normal Conc Needed for Coagulation:
Intrinsic System Only
IX Christmas factor

A

40

42
Q

% of Normal Conc Needed for Coagulation:
Intrinsic System Only
VIII Antihemophilic factor A

A

30

43
Q

% of Normal Conc Needed for Coagulation:
Extrinsic System Only
VII Proconvertin

A

25

44
Q

% of Normal Conc Needed for Coagulation:
Common Pathway
X Stuart factor

A

40

45
Q

% of Normal Conc Needed for Coagulation:
Common Pathway
V Proaccelerin, labile factor

A

40

46
Q

% of Normal Conc Needed for Coagulation:
Common Pathway
II Prothrombin

A

40

47
Q

% of Normal Conc Needed for Coagulation:
Common Pathway
I Fibrinogen

A

100 mg/dL

48
Q

Control of Blood-Surface Interface:

Develop biomaterial that mimics the endothelial cell layer (2)

A

surface-bound heparin

surface-modifying additives

49
Q

Control of Blood-Surface Interface:

Prevent or block activation of the blood during bypass=

A

blood modification

50
Q

Control of Blood-Surface Interface:

Prevent activated blood from reaching your circuit=

A

Sequestered cardiotomy suction

51
Q

Surface-Bound Heparin is ____ and _____

A

ionic and covalent

52
Q

Surface-Bound Heparin claims (5)

A

suppress thrombin formation
reduce blood loss & transfusion requirements
attenuate inflammatory response
depress platelet activation
decrease in clinical indicators of morbidity

53
Q

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

A
  • post-op bleeding and transfusion requirements
  • attenuation of complement
  • decreased activation of neutrophils and monocytes
54
Q

Surface-Modifying Additives for Terumo

A

X Coating (poly(2-methoxyethylacrylate) (PMEA)-NO heparin)

55
Q

Surface-Modifying Additives for Medtronic (3)

A
  1. Carmeda (HEPARIN coating – covalent bonded)
  2. Trillium (HEPARIN coating – covalent bonded)
  3. Balance Biosurface (hydrophilic polymer coating-NO heparin)
56
Q

Surface-Modifying Additives for Maquet (2)

A
  1. Bioline (combined albumin and HEPARIN coating )

2. Softline (hydrophilic & hydrophobic polymer coating-NO heparin)

57
Q

Surface-Modifying Additives for Sorin

A

P.h.i.s.i.o (synthetic phosphorylcholine-NO heparin)

58
Q

Blood Modification:

Preop administration of ______ attenuates complement activation

A

corticosteroids

59
Q

Blood Modification: Antifibrinolytic agents: Aprotinin=

A

inhibits plasmin directly

high dose partially inhibits kallikrein – platelet sparing

60
Q

Blood Modification: Antifibrinolytic agents: W-aminocarboxylic acids=

A

inhibit cleavage of plasminogen to plasmin

61
Q

Blood Modification: Antifibrinolytic agents: (4)

A

Aprotinin
W-aminocarboxylic acids
Tranexamic acid
ε-aminocaproic acid

62
Q

Blood Modification:

Platelet anesthesia= (3)

A

Reversible inhibition of platelets during procedure
Eptifibatide (Integrilin) with or without nitric oxide
Nitric oxide provides partial protection

63
Q

Blood Modification: Complement inhibition= (2)

A

Pexelizumab

TP 10

Perf Tech Exam 3 (4 decks)

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