Opsonic fibronectin after operation or trauma: effect of hemodilution and duration of operation

Fibronectin is an essential opsonin for phagocytosis of nonbacterial particulate matter by the reticuloendothelial system (RES). Fibronectin deficiency causes RES phagocytic depression and repletion of fibronectin reverses RES depression. Fibronectin depletion has been linked with multiple organ failure after surgery and trauma in patients with intra-abdominal infection. The mechanisms for fibronectin depletion have not been established. Plasma fibronectin levels were measured in 29 patients requiring operation after trauma and 15 patients undergoing elective abdominal operations. Opsonic fibronectin fell in the immediate postoperative period and on the first postoperative day in both groups. Total fluid replacement, blood loss, and operative time did not correlate with depression in fibronectin levels after trauma, although a weak correlation may exist between total fluid administration and fibronectin concentration in postoperative patients. Total fluid replacement, blood loss, and operative time may be contributing factors, but are not the major determinants of fibronectin deficiency after trauma or operation.