Koagülasyon Sistemi ve EKMO

ecmo-kapak

Prof. Dr. Ferit AVCU
GATA, Hematoloji BD, Ankara

Özet
EKMO uygulamalarında morbidite ve mortalitenin en önemli sebebi kanama ve tromboembolik olaylardır. Kan hücresel elemanlarının biyolojik olmayan yüzeyle teması, yaygın inflamasyon ve koagülasyon yanıtı oluşturur. En önemli basamaklar temas aktivasyonu ve trombosit aktivasyonudur. Artan fibrinojen trombosit adezyonuna sebep olurken, trombin ve heparin gibi faktörler trombositleri aktive eder. Trombositler aktive oldukları zaman yapışkan hale gelir ve granüllerinde depolanan birçok maddeyi ortama salarlar. Ayrıca agregasyon ve trombositlerin yüzeye yapışması sonucu trombosit seviyesinde azalma gerçekleşir. Kanın EKMO sırasında yabancı bir yüzey ile teması intrensek koagülasyon yolağın aktivasyonuna, doku hasarı veya inflamasyon sonucu doku faktörü (TF)nün salınması ekstrensek yolağın aktive olmasına neden olur. Ortak yolağın sonucu trombin oluşumudur. Ama trombin oluşumu sonucu oluşan fibrin aynı zamanda fibrinolizi başlatır. EKMO aynı zamanda fagositozu tetikleyen inflamatuar mediatörlerin oluşumuna, hücre lizisine, antikor aracılı immün yanıta sebep olan kompleman aktivasyonuna da sebep olur.

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