The monocyte dysfunction induced by acute tetramine poisoning and corrected by continuous blood purification

The monocyte function of patients with severe tetramine poisoning and the effects of sequential hemoperfusion (HP) and continuous veno-venous hemofiltration (CVVH) on the immune status of the patients were investigated. Eleven patients with severe acute tetramine poisoning were treated with sequential HP and CVVH. The APACHE II score and Glasgow score were used to evaluate the disease status during the therapy. Blood samples were collected at 0, 2, 6, 12, 24, 48, and 72 h. Peripheral monocytes were isolated and stimulated with lipopolysaccharide (LPS) to detect the ability of monocytes to secrete tumor necrosis factor-alpha (TNF-alpha), interleukin (IL)-6, and IL-10. The number of monocytes was counted at the same time. As expected, three patients died and the clinical manifestations were improved in the other patients. The production of cytokines (TNF-alpha, IL-6, and IL-10) by monocytes of patients with tetramine poisoning was much lower than normal controls (P<0.001), and was significantly increased after HP and CVVH in the survivors (TNF-alpha, IL-6, IL-10, P<0.05, P<0.01, P<0.05, respectively). The blood concentration of tetramine was 0.124+/-0.082 mg/l at prehemoperfusion and 0.080+/-0.055 mg/l at posthemoperfusion (P<0.05). It was concluded that there was severe damage to monocyte function in patients with tetramine poisoning, and that sequential HP and CVVH can effectively ameliorated monocyte function and eliminate tetramine from blood.