Lymphoid response of the burn patient

Clinical observations have long suggested immunologic compromise in burned patients. Resolution of the immune system into cooperative dual components of T-cells mediating delayed hypersensitivity and B-cells mediating antibody responses prompted the present survey of T-cell and B-cell changes after acute thermal burn injury. Adults and children sustaining extensive burn injuries were studied for up to 60 days after injury. T-cell function was assessed by lymphocyte counts, in vitro lymphocyte synthesis of RNA and DNA with and without mitogenic stimulation, and lymphocyte response and stimulatory capacities in the mixed lymphocyte culture (MLC) reaction. B-cell function was studied by quantitation of the major classes of circulating immunoglobulins. Transient lymphocytopenia, increased RNA and DNA synthesis rates by both mitogenstimulated and unstimulated lymphocytes, and impairment of lymphocyte response and stimulation in the MLC were observed early in the postburn period. These parameters tended to normalize by the third week after injury. Immunoglobulin levels, particularly IgG, were depressed significantly the first week postburn, but were normal or elevated by 60 days. These studies document both T-cell and B-cell changes postburn,which appear to be reversible with the recovery phase. A transient shift of circulating lymphocytes toward the B-cell type is suggested and early depression of immunoglobulin levels is notable. Both types of changes likely contribute to the immunologic compromise of the acutely burned patient.