Effects of cardiopulmonary bypass on pulmonary leukostasis and complement activation.
We measured white blood cell counts and complement component (C3a, C4a, and C5a) and prostacyclin levels, and studied lung biopsy specimens, in 16 patients undergoing cardiopulmonary bypass and compared them with four patients undergoing other pulmonary procedures. Bypass caused no significant elevation in peripheral venous white blood cell counts. Higher counts were present in the right atrium compared with the left atrium. Patients who underwent bypass had elevated complement component and prostacyclin concentrations before operation and these levels increased further during operation. Trapping of polymorphonuclear leukocytes occurred in pulmonary alveolar capillaries and venules after bypass. We conclude that bypass activates complement components primarily of the alternative pathway and leads to increased blood prostacyclin levels. These changes are accompanied by polymorphonuclear leukocyte accumulation in the lungs and may be important in initiation of the adult respiratory distress syndrome in these patients.
Howard
R J
RJ
Department of Surgery, University of Florida, College of Medicine, Gainesville 32610.
Crain
C
C
Franzini
D A
DA
Hood
C I
CI
Hugli
T E
TE
D015121:6-Ketoprostaglandin F1 alpha / Q000097:blood*; D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000097:blood* / Q000473:pathology / Q000601:surgery; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D003167:Complement Activation; D003176:Complement C3 / Q000032:analysis; D003181:Complement C4 / Q000032:analysis; D003182:Complement C5 / Q000032:analysis; D003170:Complement Pathway, Alternative; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000209:etiology* / Q000473:pathology; D008168:Lung / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009504:Neutrophils; D010976:Platelet Count; D013997:Time Factors
D003176:Complement C3; D003181:Complement C4; D003182:Complement C5; D015121:6-Ketoprostaglandin F1 alpha