Significance of immunoreactivity in trauma

Anergy is a crude measure of host resistance which may be due to malnutrition, but is probably more often due to inappropriate host responses to surgery and injury. Severe injury and infection decrease chemotaxis and the migration of neutrophils to areas of irritation. Lymphocytes from anergic patients are not properly functional in the DTH reaction, probably because of circulatory inhibitors in vivo. These lymphocytes can elicit a response when cultured in normal serum in vitro. B cell function is also impaired in anergic patients in that they do not respond to tetanus toxoid in vivo or in vitro. There is no randomized study which shows conclusively that one should delay elective surgery in anergic patients who are malnourished. Active immunization may become a reality in the prevention of surgical infections. Immunomodulators which favourable affect T and B cell function may also become a part of our armamentarium.