[Hemophagocytosis during multiple organ failure: M-CSF overproduction or viral reactivation?].
OBJECTIVE
This study was aimed to assess the potential role of M-CSF and viral reactivation in the genesis of haemophagocytosis during the multiple organ failure (MOF) syndrome.


METHODS
Twenty-five patients (mean age: 60 +/- 16 years; Apache II: 23 +/- 5) sustaining MOF with an unexplained thrombocytopenia were studied. In each patient, a bone marrow aspirate, serum M-CSF concentration, and a virological examination (Herpes viruses) were obtained on admission. In addition, 20 patients (mean age: 57 +/- 15 years; Apache II: 24 +/- 7) with at least two organ failures but no thrombocytopenia constituted the control group. Circulating M-CSF levels and the frequency of virus reactivation were compared between groups.


RESULTS
Haemophagocytosis was diagnosed in 11/25 patients (44%). No viral reactivation was found. Serum M-CSF concentrations were higher in the presence of haemophagocytosis (699 +/- 242 vs 438 +/- 157 IU.mL-1; p < 0.05). Ferritin levels were also increased in the presence of a macrophage activation (3,258 +/- 2,807 vs. 520 +/- 280 mg.L-1; p < 0.0001). In contrast, both circulating M-CSF and ferritin levels were similar between thrombocytopenic patients with no hemophagocytosis and controls.


CONCLUSIONS
This study confirmed the high incidence of haemophagocytosis in critically ill patients sustaining MOF. In this setting, circulating M-CSF levels were markedly elevated, whereas no Herpes viruses reactivation was found.
François
B
B
Service de réanimation, CHU Dupuytren, 2, avenue Martin Luther King, 87042 Limoges, France. realim@unilim.fr
Trimoreau
F
F
Desachy
A
A
Besse
A
A
Rangez
S
S
Praloran
V
V
Vignon
P
P
D000368:Aged; D001343:Autophagy / Q000502:physiology*; D005260:Female; D005293:Ferritins / Q000378:metabolism; D006801:Humans; D016173:Macrophage Colony-Stimulating Factor / Q000378:metabolism*; D008297:Male; D008526:Medulla Oblongata / Q000378:metabolism* / Q000821:virology; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000276:immunology* / Q000378:metabolism / Q000821:virology*; D013921:Thrombocytopenia / Q000097:blood; D014780:Viruses / Q000276:immunology*
D016173:Macrophage Colony-Stimulating Factor; D005293:Ferritins