The effect of surgical operation upon monocytes

Effects of surgical stress on early nonspecific immune response in children

Surgery alters the body's homeostatic balance and defense mechanisms. In adults transient postoperative cellular and humoral immunosuppression after different degrees of operative stress has been reported. In children the immunologic consequences of operations are not elaborated. This study investigates the effect of minor and major surgery on early nonspecific immune response in terms of neutrophil counts and function. Forty-three children undergoing minor and major elective procedures were studied. Blood samples were collected before, immediately after, and 72 h after surgery. Total white cell count, differential neutrophil count, and neutrophil phagocytic function were studied using nitroblue tetrazolium test. Children were divided into two groups-group 1 underwent minor surgery and group 2 major surgery. In group 1 there was a significant drop in total counts after surgery, but in group 2 total counts were not affected. In both groups, the percentage of neutrophils increased immediately after surgery but fell to near or less than preoperative levels 72 h after surgery. However, the assessment of neutrophil functions by nitroblue tetrazolium test in both unstimulated and stimulated forms revealed it to be unchanged in group 1. In group 2 the unstimulated neutrophil function was elevated 72 h after surgery, whereas stimulated function was elevated immediately after surgery. Minor surgery does not alter the early nonspecific immune response. However, major surgery seems to induce a transient increase in neutrophil phagocytic activity.

HLA class II antibodies in transfusion-related acute lung injury (TRALI). A case report

TRALI, a serious complication of blood transfusion, is underdiagnosed. Anti-granulocyte and anti-HLA class I molecules in donors or recipients and very recently, lipids in stored blood as well as anti-HLA class II have been associated with the syndrome. We present a TRALI case which occurred in a 56 year old woman after plasma transfusion. HLA class II antibodies were identified in the donor and were correlated with the recipients' HLA antigens. The presence of HLA class II antibodies without anti-HLA class I has been reported in very few cases and may facilitate the understanding of the pathogenesis of the syndrome.

TRALI: correlation of antigen-antibody and monocyte activation in donor-recipient pairs

BACKGROUND

TRALI may be a severe reaction associated with transfusion of plasma-containing blood components. TRALI has usually been associated with antibodies against granulocytes and HLA class I antigens, but more recently with antibodies against HLA class II and monocytes. TRALI cases were investigated to determine correlation between antigen and antibody. Additionally, activation of monocytes by TRALI serums was studied.

STUDY DESIGN AND METHODS

Sixteen cases of TRALI were investigated. All patients were typed for HLA antigens. Implicated donors were screened for HLA antigens and antibodies against granulocytes and monocytes. In 6 cases, recipient monocyte activation was measured in vitro after incubation with TRALI and control serums. In four cases, monocyte activation was measured after incubation of TRALI serums against a panel of monocytes of known HLA antigen type.

RESULTS

In 14 of the 16 cases (87.5%), antigen-antibody correlation was identified. TRALI monocytes, incubated with implicated TRALI serum (n = 6), expressed significantly greater cytokine and tissue factor (p < 0.05, repeated-measures ANOVA) than controls. Panel monocytes incubated with TRALI serum showed increased expression of cytokine and/or tissue factor when corresponding antigen was present.

CONCLUSION

In most cases of TRALI, a correlation between antigen and antibody can be identified. Activation of monocytes and their subsequent release of cytokines may play a role in the pathogenesis of TRALI.

HLA class II antibodies in transfusion-related acute lung injury

BACKGROUND

Transfusion-related acute lung injury (TRALI) is a serious, sometimes fatal, complication of transfusion. Granulocyte and HLA class I antibodies present in blood donors have been associated with TRALI. HLA class II antibodies have recently been described in a few cases of TRALI.

STUDY DESIGN AND METHODS

Donors involved in TRALI reactions reported to a blood center over an 18-month period were tested for HLA class I and II antibodies as well as granulocyte antibodies, if HLA antibodies were not identified.

RESULTS

HLA class II antibodies were identified, in at least one donor, in 7 (64%) of 11 cases of TRALI. HLA class I antibodies were identified in combination with HLA class II antibodies in 5 of these 7 cases. HLA class I antibodies were exclusively identified in 2 cases. Granulocyte antibodies were identified in 1 case, and no antibodies were identified in another.

CONCLUSION

In addition to HLA class I antibodies, HLA class II antibodies are associated with TRALI. Testing of donors for HLA class II antibodies as well as HLA class I and granulocyte antibodies is recommended as part of the investigation of suspected cases of TRALI.

Impaired leukocyte phagocytosis in patients undergoing hemihepatectomy for liver metastases

Patients undergoing partial hepatectomy have an increased susceptibility to infection. To investigate whether this increased risk is related to impaired leukocyte function, we studied polymorphonuclear leukocyte (PMN) phagocytosis in patients undergoing a hemihepatectomy because of liver metastasis (LM, n = 11) and in patients undergoing major abdominal surgery because of abdominal malignancy (AM, n = 8). Eight healthy volunteers (HVs) served as controls. Leukocyte suspensions were incubated with fluorescein isothiocyanate-labeled Staphylococcus aureus, and phagocytosis was measured by flow cytometry. Preoperative PMN phagocytosis, in the presence of autologous plasma, was significantly less in patients with LM compared with patients with AM or HVs. This impaired phagocytosis was potentially restored in the presence of normal plasma. The decreased phagocytic capacity of PMNs from patients with LM was not related to levels of known plasma opsonins or phenotypic changes of PMNs. Rather, it was related to a deficiency of unidentified plasma factors. After surgery, the phagocytic capacity of PMNs of patients with AM decreased by approximately 30%, which correlated with decreasing levels of immunoglobulin G and C3. In conclusion, patients with LM had a decreased PMN phagocytic capacity before surgery. This impairment in phagocytosis disappeared 1 week after surgery. We propose that the presence of LM leads to a deficiency of factor(s) in the blood that impairs PMN phagocytic capacity.

Effects of anaesthesia and surgery on the immune response

Alterations have been found to occur in every component of immune response during anaesthesia and surgery. These alterations represent the body's general physiological responses and are mainly dependent on the extent of surgery, as well as other factors such as the patient's age and health status, medication and blood transfusion. Anaesthetic and operative complications have profound effects on these responses. Basically, the immune response to anaesthesia and surgery is a beneficial reaction, needed in local host defences and wound healing and in preventing the body from making autoantibodies against its own tissues. The responses may, however, contribute to the development of postoperative infections and spread of malignant disease. During uncomplicated conventional surgery, the immune response usually passes clinically unnoticed without any harmful effects. Absent responses and excessively high responses, on the other hand, harm the patient. Our understanding of immunological phenomena and our possibilities of controlling mediator activation are now lagging behind the technical advances made in operative treatment. If we want to decrease operative morbidity and mortality to below their present levels, more attention should be directed to immune responses to major surgery, injuries and operative complications with massive mediator release which place the surgical patient at risk. Experimental evidence suggests that results of treatment in injured and operated patients can in the future be improved by controlling immune responses and their mediator systems. Our current level of knowledge of immune responses is already helping us to avoid many immune-mediated complications. However, routine interference with these responses is not indicated.

Calprotectin (the L1 protein) during surgery in patients with rheumatoid arthritis

Calprotectin (L1) is a major leukocyte protein which is released during activation or death of neutrophil granulocytes and monocytes. Previous studies have shown that L1 may be a useful marker of disease activity in patients with adult or juvenile rheumatoid arthritis (RA). In the present study, the plasma concentrations of L1 were analysed during shoulder-joint surgery in 16 patients with adult or juvenile RA. Decreased L1 concentrations were found 48 h postoperatively. Thereafter, the L1 concentrations were increased at 72 h, with a following decrease until day 14 postoperatively. In contrast, increased serum concentrations of both C-reactive protein (CRP) and orosomucoid (i.e. alpha 1-acid glycoprotein) were found at 48 h after surgery. Plasma samples obtained before and after surgery were analysed by gel filtration. Approximately 3/4 of the plasma L1 was found in fractions corresponding to the native molecule, while the rest was detected in higher molecular mass fractions. The distribution of L1 antigen in low and high molecular mass regions did not differ between the pre- and postoperative plasma samples. The L1 protein consists of light and heavy chains. Increased serum levels of the cystic fibrosis antigen, which is identical to L1 light chain, have been described in patients with cystic fibrosis. The existence of circulating free L1 chains was presently investigated in plasma obtained before and after surgery. After gel filtration of plasma samples, no free L1 chains were detected by use of enzyme immunoassay and dot blot.

The patterns of stress response in patients undergoing thyroid surgery under acupuncture anaesthesia in China

The patterns of catecholamines (adrenaline and noradrenaline), peptide hormones (adrenocorticotropic hormone, antidiuretic hormone, beta-endorphin, growth hormone and prolactin), hydrocortisone (cortisol) and those of immunoglobulins (IgA, IgG and IgM) and total and differential leucocyte counts in the peripheral blood were investigated during and for 6 days after thyroid surgery in 20 patients (F/M: 18/2) performed under acupuncture anaesthesia, supplemented by small doses of pethidine (mean: 45.0 mg, s.d. 8.9). Throughout surgery the patients remained conscious. During surgery a significant increase in the level of catecholamines and the above-mentioned circulating hormones and a decrease of immunoglobulins were observed, whereas the leucocyte and differential counts demonstrated leucocytosis due to lymphocytosis, a decreased percentage of eosinophils and a remarkably reduced percentage of neutrophils. In the postoperative phase, levels of noradrenaline and beta-endorphin remained elevated, whereas the other circulating hormones gradually returned to normal values. Immunoglobulin levels and eosinophil counts returned to the preinduction values within 24 h, and those of neutrophil and lymphocyte counts within 2 days. Changes in number of monocytes and basophils could not be detected peri- and postoperatively.

Influence of surgery on the responsiveness of blood lymphocytes in patients with advanced cancer

The effect of surgery on peripheral blood mononuclear cell responsiveness to mitogens and suppressor cell (SC) activity assessed in a concanavalin A (ConA) assay were studied in patients with stage 0 and stage III-IV cancer. Patients were exposed to a similar surgical trauma the same type of anaesthesia, and to no pre- and early postoperative radio- or chemotherapy. A more pronounced postoperative decrease in the lymphocyte count, responsiveness to phytohemagglutinin (PHA) and ConA, and in the SC activity was found in the nonadvanced than advanced cancer group. These findings point to an impaired mobilization and distribution capacity of circulating lymphocytes in patients with advanced neoplastic disease.

The effect of surgery and anesthetic agents on granulocyte-chemiluminescence in whole blood

The effect of anesthesia and major abdominal surgery on zymosan-induced chemiluminescence (CL) of neutrophil granulocytes was evaluated. CL was measured in diluted whole blood taken at distinct intervals within the perioperative period. In addition, blood samples from healthy volunteers were supplemented with ether and halothane to investigate the in vitro effect of these agents. The phagocytosis-induced CL was not found to be depressed by anesthesia and surgery. Only at supranarcotic concentrations was CL reduced. Surgery and anesthesia, therefore, do not appear to impair this defense system significantly under the conditions of this investigation.

Monocyte functions are depressed during and after surgery under general anaesthesia but not under epidural anaesthesia

Monocyte functions have been investigated in 18 patients undergoing total hip arthroplasty performed under either general anaesthesia or epidural anaesthesia. Serum cortisol increased significantly both per- and postoperatively in the general anaesthesia group compared to minor changes in the epidural group. The spreading of monocytes on plastic surfaces possibly reflects the phagocytic capacity of the cells. This spreading index of monocytes derived from patients operated under epidural anaesthesia and cultured in medium containing autologous serum showed a significant increase per- and postoperatively compared to the spreading index of monocytes from patients operated under general anaesthesia. This difference increased with increasing culture time. The ability of monocytes to induce lysis in malignant cells was reduced to 45% peroperatively in monocytes derived from patients operated under general anaesthesia and cultured in medium containing autologous serum. In the epidural group the lysis was nearly unchanged from the preoperative value, making the difference between the groups highly significant (P less than 0.01). On the first postoperative day, the difference between the groups was less pronounced. The differences in spreading index and cytolytic capacity were not seen when the monocytes were cultured in medium with pooled AB-serum, thus indicating a serum factor responsible for the monocyte depression when the patients were operated under general anaesthesia.