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Complement activation during bypass in acquired C1 esterase inhibitor deficiency.

R S Bonser¹, J Dave, J Morgan

¹Brompton Hospital, London, United Kingdom.

The Annals of Thoracic Surgery

|September 1, 1991

Summary

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This study tracked complement activation during heart surgery in a patient with C1 esterase inhibitor deficiency. Exaggerated complement common pathway activation led to a fatal hemostatic disorder despite treatment.

Area of Science:

Immunology
Cardiovascular Surgery
Complement System Biology

Background:

Acquired C1 esterase inhibitor deficiency is a rare condition impacting the complement system.
Cardiopulmonary bypass (CPB) can trigger inflammatory responses, including complement activation.
Monitoring complement pathways during CPB is crucial for understanding patient outcomes.

Observation:

Serial complement estimations were performed during CPB in a patient with acquired C1 esterase inhibitor deficiency.
Classic and alternative complement pathway activation appeared within expected limits.
A significant and exaggerated activation of the common complement pathway was observed.

Findings:

The C3d:C3 ratio showed a massive increase, indicating extensive complement component C3 cleavage.

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This exaggerated common pathway activation correlated with a severe hemostatic disorder.

The patient developed pulmonary edema and circulatory collapse.

Implications:

This case highlights the critical role of the complement common pathway in CPB-associated coagulopathy.
Understanding complement dysregulation is vital for managing complex surgical patients.
Further research into targeted complement inhibition during CPB may be warranted.