Anergy and altered lymphocyte function in the injured patient

The failure of the host-defense mechanism following trauma has been recognized, but the site of the deficit is unknown. The immunologic competence of 16 patients, including 15 who had minor injuries and required less than 4 transfusions, was prospectively studied with skin testing, leukocyte counts, and protein electrophoresis. The stimulation ratio (SR) and index of lymphocyte response to phytohemagglutanin (PHA) were measured as the ratio of thymidine uptake in stimulated cells to that of resting cells in both pooled normal serum as well as each patient's serum. Six patients, including the one patient with major injury, had no response to any of the four skin test antigens and were considered anergic (AN). Ten patients with minor trauma responded to at least one of the antigen skin tests and were considered nonanergic (NA). The anergic patients had significantly more shock and more blood transfusions and had significantly lower serum albumin levels. There was no statistical difference between the anergic and nonanergic groups in leukocyte count, absolute lymphocyte count, gamma-globulin fraction, or age. The average PHA Stimulation Ratio of patient lymphocytes in patient serum was significantly higher than the PHA Stimulation Ratio of patient lymphocytes in control serum. This suggests that the lymphocytes of injured patients respond in a greater magnitude when bathed in autologous-serum than when bathed in control pooled serum. Furthermore, the autologous serum did not inhibit the PHA response of control or normal lymphocytes. The presence of an enhancing factor in injured patients' sera or an absence of a supressor substance may be responsible for this phenomenon.