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The effects of anesthesia and surgery on lymphocyte populations and function in infants and children
M P Platt1, P E Lovat, J G Watson
1Department of Child Health, Newcastle upon Tyne, England.
Insights
Major surgery in children causes a significant drop in helper T cells, impacting immune function. This reduction in lymphocyte counts and function suggests reduced immune competence post-operation.
Area of Science:
- Immunology
- Pediatric Surgery
Background:
- Surgical stress can induce lymphopenia (low lymphocyte count).
- The specific lymphocyte subsets affected by surgical stress in children are not well-defined.
Purpose of the Study:
- To investigate if surgical stress selectively depletes specific lymphocyte subsets in children.
- To assess the impact of surgery on lymphocyte counts, helper:suppressor ratios, and lymphocyte function in pediatric patients.
Main Methods:
- Blood samples collected from 22 children pre- and post-surgery (at 6, 12, 24, and 48 hours).
- Lymphocyte subsets identified and quantified using monoclonal antibodies and indirect immunofluorescence.
- Lymphocyte function assessed via response to pokeweed mitogen and concanavalin A.
Main Results:
- A significant decrease in total lymphocyte count observed by 6 hours post-surgery, primarily due to a reduction in helper T cells.
- Helper T cell counts and the helper:suppressor T cell ratio remained depressed for at least 48 hours.
- Reduced lymphocyte function was noted 6 hours post-surgery, independent of patient age.
Conclusions:
- Major surgery in children leads to a selective depletion of helper T lymphocytes and impaired lymphocyte function.
- Pediatric patients exhibit reduced immune competence in the immediate postoperative period.
- Further research is needed to determine the duration of this immune suppression and its link to infection risk.
Abstract:
A study was designed to test the hypothesis that the lymphopenia caused by surgical stress in children may arise through selective depletion of one or more lymphocyte subsets. Blood samples from 22 children were taken pre- and postoperatively and 6, 12, 24, and 48 hours after surgery. Lymphocyte subsets were identified and counted using monoclonal antibodies and indirect immunofluorescence. By six hours postoperatively, the mean total lymphocyte count had fallen by 1.87 x 10(9)/L (P less than .01); this was largely due to the fall in helper T cells (1.53 x 10(9)/L, P less than .01) and both counts remained depressed for at least 48 hours. The helper:suppressor ratio also fell, from 3.42 to 1.92 (P less than .01), but had recovered by 48 hours. Lymphocyte function as measured by the response to pokeweed mitogen and concanavalin A was also reduced six hours postoperatively. These changes were independent of age. Major surgery in infants and children causes a selective reduction in helper T lymphocyte numbers, helper:suppressor ratio, and lymphocyte function. This suggests that immune competence in the immediate postoperative period in children is reduced, as it is in adults. The duration of this and its relationship to infection are not yet known.