A study of the effects of extracorporeal circulation on the immunologic system of humans.
OBJECTIVE
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.


METHODS
A prospective study from 20 consecutive patients.


METHODS
The same team operated on all patients in a major teaching hospital, and the immunologic tests were performed in the hospital's hematology laboratory.


METHODS
Twenty patients were studied who had consented to participate in the study.


METHODS
All patients underwent valve replacement under general anesthesia.


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.
Siminelakis
S
S
Department of Anesthesia, Hippokration General Hospital of Athens, Greece.
Bossinakou
I
I
Antoniou
F
F
Pallanza
Z
Z
Tolios
J
J
Vasilogiannakopoulou
D
D
Kasapli
M
M
Parigori
P
P
Chlapoutakis
E
E
D000368:Aged; D003167:Complement Activation; D003176:Complement C3 / Q000032:analysis; D005112:Extracorporeal Circulation; D005260:Female; D006801:Humans; D007107:Immune System / Q000503:physiopathology*; D007958:Leukocyte Count; D008214:Lymphocytes / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000515:alpha 1-Antitrypsin / Q000032:analysis
D003176:Complement C3; D000515:alpha 1-Antitrypsin