Biological Consequences of the Blood–Surface Interaction
This chapter builds on the two previous discussions of the basic interaction of surfaces with proteins and cells through an evaluation of the consequences of such processes in terms of deleterious effects associated with medical devices. The first step in the chain of biological events that occurs as a result of exposure of blood to, for example, solid materials is often considered to be the adsorption of the higher concentration proteins in the biological fluid. The chapter then proceeds to a detailed look at the nature of platelet aggregation and the fibrinolytic response, often referred to as the coagulation cascade, introduced in the previous section. This is followed by a description of the response of blood to exposure to foreign bodies with respect to the activation of inflammatory effects and the complement system, and the instigation of infection. The chapter concludes with a discussion of the nature of the contact of blood with implantable medical devices such as stents, vascular grafts, and heart valves. Included here is a look at the role played by blood–substrate interactions, where the fluid is flowed extra-corporeally such as in medical procedures of bypass surgery and renal dialysis.