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A study of the effects of extracorporeal circulation on the immunologic system of humans
S Siminelakis1, I Bossinakou, F Antoniou
1Department of Anesthesia, Hippokration General Hospital of Athens, Greece.
Objectives:
The objectives of this study were to quantify the immunosuppressive effects of cardiopulmonary bypass (CPB) and to identify mechanisms responsible for the postoperative immunosuppression of patients undergoing cardiac surgery.
Design:
A prospective study from 20 consecutive patients.
Setting:
The same team operated on all patients in a major teaching hospital, and the immunologic tests were performed in the hospital's hematology laboratory.
Participants:
Twenty patients were studied who had consented to participate in the study.
Interventions:
All patients underwent valve replacement under general anesthesia.
Measurement And Main Results:
The changes in the white blood cell count (WBC), in the B, T, T4, T8 lymphocytes, the concentrations of C-reactive protein (CRP), a1-antitrypsin (A1AT), a2-macroglobulin (A2MG), C3, C4 immunoglobulin A (IgA), IgM, IgG, Kappa (K), and lambda (L) chains were studied. The postoperative immune response was expressed with (1) increased mean axillary temperature (37.5 degrees +/- 0.62 degrees) in the first postoperative 24 hours; (2) increase of WBC (p < 0.001) and T8 (p < 0.01); (3) reduction of C3 (p = 0.01) and A2MG (p < 0.01); (4) reduction of IgA (p < 0.001) and IgG, K, L chains (p < 0.01); and (5) reduction of T (p < 0.01) and T4 (p < 0.01). In the first 24 hours postoperatively, B cells were increased (81%) together with CRP (p < 0.01) and A1AT.
Conclusions:
The observed immune alterations were mostly of no immunologic origin and were related to hemodilution and inflammation together with an immunosuppressive effect of trauma and stress.