Primary and secondary leucocyte changes following the intramuscular injection of epinephrine hydrochloride

The Magnitude of Postconvulsive Leukocytosis Mirrors the Severity of Periconvulsive Respiratory Compromise: A Single Center Retrospective Study

Background: Generalized epileptic convulsions frequently exhibit transient respiratory symptoms and non-infectious leukocytosis. While these peri-ictal effects appear to arise independently from one another, the possibility that they stem from a common ictal pathophysiological response has yet to be explored. We aimed to investigate whether peri-ictal respiratory symptoms and postictal leukocytosis coexist.

Methods: We performed a single center retrospective chart review of 446 patients brought to our emergency department between January 1, 2017 and August 23, 2018 for the care of generalized epileptic convulsions with or without status epilepticus. We included 152 patients who were stratified based on the presence (PeCRC+) or absence (PeCRC–) of overt periconvulsive respiratory compromise (PeCRC). In addition, patients were stratified based on the presence or absence of postconvulsive leukocytosis (PoCL), defined as an initial postconvulsive white blood cell (WBC) count ≥ 11,000 cells/mm³. Triage vital signs, and chest x ray (CXR) abnormalities were also examined.

Results: Overt PeCRC was observed in 31.6% of patients, 43% of whom required emergent endotracheal intubations. PoCL was observed in 37.5% of patients, and was more likely to occur in PeCRC+ than in PeCRC– patients (79.2 vs. 18.2%; OR = 17.0; 95% CI = 7.2–40.9; p < 0.001). Notably, the magnitude of PoCL was proportional to the severity of PeCRC, as the postconvulsive WBC count demonstrated a negative correlation with triage hemoglobin oxygen saturation (R = −0.22; p < 0.01; CI = −0.48 to −0.07). Moreover, a receiver operating characteristic analysis of the WBC count's performance as predictor of endotracheal intubation reached a significant area under the curve value of 0.81 (95% CI = 0.71–0.90; p < 0.001). Finally, PeCRC+ patients demonstrated frequent CXR abnormalities, and their postconvulsive WBC counts correlated directly with triage heart rate (R = 0.53; p < 0.001).

Conclusion: Our data support the existence of an ictal pathophysiological response, which induces proportional degrees of PoCL and PeCRC. We suggest this response is at least partially propelled by systemic catecholamines.

The Role of Norepinephrine and α-Adrenergic Receptors in Acute Stress-Induced Changes in Granulocytes and Monocytes

OBJECTIVE

Acute stress induces redistribution of circulating leucocytes in humans. Although effects on lymphocytes as adaptive immune cells are well understood, the mechanisms underlying stress effects on granulocytes and monocytes as innate immune blood cells are still elusive. We investigated whether the stress hormone norepinephrine (NE) and α-adrenergic receptors (α-ADRs) may play a mediating role.

METHODS

In a stress study, we cross-sectionally tested 44 healthy men for associations between stress-induced NE increases and simultaneous granulocyte and monocyte cell count increases, as measured immediately before and several times after the Trier Social Stress Test. In a subsequent infusion study, 21 healthy men participated in three different experimental trials with sequential infusions of 1- and 15-minute duration with varying substances (saline as placebo, the nonspecific α-ADR blocker phentolamine [2.5 mg/min], and NE [5 μg/min]): trial 1 = saline+saline, trial 2 = saline+NE, trial 3 = phentolamine+NE. Granulocyte and monocyte cell numbers were assessed before, immediately after, 10 minutes, and 30 minutes after infusion procedures.

RESULTS

In the stress study, higher NE related to higher neutrophil stress changes (β = .31, p = .045, R change = .09), but not epinephrine stress changes. In the infusion study, saline+NE induced significant increases in neutrophil (F(3/60) = 43.50, p < .001, η = .69) and monocyte (F(3/60) = 18.56, p < .001, η = .48) numbers compared with saline+saline. With phentolamine+NE, neutrophil (F(3/60) = 14.41, p < .001, η = .42) and monocyte counts (F(2.23/44.6) = 4.32, p = .016, η = .18) remained increased compared with saline+saline but were lower compared with saline+NE (neutrophils: F(3/60) = 19.55, p < .001, η = .494, monocytes: F(3/60) = 2.54, p = .065, η = .11) indicating partial mediation by α-ADRs. Trials did not differ in eosinophil and basophil count reactivity.

CONCLUSIONS

Our findings suggest that NE-induced immediate increases in neutrophil and monocyte numbers resemble psychosocial stress effects and can be reduced by blockade of α-ADRs.

Complete blood count at the ED: preanalytic variables for hemoglobin and leukocytes

OBJECTIVE

The objective of this study is to determine the ways in which preanalytic factors related to physiologic status can affect the complete blood cell count (CBC) in patients referring to an emergency department (ED).

METHODS

Over a 1-year period, the results of hemoglobin (Hb) level and white blood cell (WBC) counts of the first CBC tests undertaken in consecutive patients (n = 11487) referring to the ED were compared with those obtained in the same patients at a second test undertaken within 24 hours of admission. A prospective evaluation of the same differences was made in another group (group 2) of 1025 consecutive ED patients, several clinical characteristics being taken into consideration.

RESULTS

Mean Hb concentrations were higher in the first (range, 8.0-15.9 g/dL) than in the second test results (median overestimation, 0.4-0.8 g/dL; P < .0001). At multivariate analysis of results in group 2 patients, fluid administration (>0.5 L) and the presence of edema played a significant role in the initial overestimation of Hb level (P = .001 and P = .045, respectively). The comparison between leukocyte counts (WBC) showed that values from the first were higher than those in the second test (median overestimation ranging from 0.42 to 3.63 × 10(9)/L cells, in the range counts from 4.0 to 30.0 × 10(9)/L). None of the clinical factors studied appeared to have affected this overestimation.

CONCLUSIONS

On interpreting CBC results in patients admitted to the ED, physicians must consider the effect of physiologic variables on Hb level (mainly hydration status) and WBC count (mental and physical stress).

A comparative study of internal laser-assisted and conventional liposuction: a look at the influence of drugs and major surgery on laboratory postoperative values

BACKGROUND

Liposuction is a type of aesthetic surgery that has been performed on humans for decades. There is not much literature addressing the subject matter of pre- and post-surgery blood parameters, although this information is rather interesting. Documentation on patients who received laser-assisted liposuction treatment is particularly scarce. Until now, there has been no literature showing values of platelets, lymphocytes, and neutrophils after liposuction.

PURPOSE

The aim of the work is to analyze and interpret values of platelets, lymphocytes and neutrophils in patient blood before and after liposuction, a surgery in which an extraordinarily large amount of potent drugs are used. Moreover, the aim is to compare values changes in patients of conventional and laser-assisted liposuction.

MATERIAL AND METHODS

We evaluated standard blood samples in patients prior to and after liposuction. This paper covers the number of platelets, lymphocytes, and neutrophils. A total of 54 patients were examined. Moreover, we compared the change in postoperative values in laser-assisted liposuction patients with the change of values in conventional liposuction patients. A paired two-sided Student's t-test was used for statistical evaluation. P < 0.005 was acknowledged to be statistically significant.

RESULTS

Values of platelets were raised both in conventional and in laser-assisted liposuction patients, but this difference was statistically non-significant and levels of platelets were still normal and within the range of blood levels in healthy patients. Values of neutrophils rose by up to 79.49% ± 7.74% standard deviation (SD) and values of lymphocytes dropped by up to 12.68% ± 5.61% SD. The before/after variances of conventional tumescent local anesthesia liposuction and variations in laser-assisted liposuction were similar for all measured parameters; they also showed no statistically significant differences between before and after surgery. The mean value of total operation time without laser-assistance was 3 hours 42 minutes (± 57 minutes SD, range 2 hours 50 minutes to 5 hours 10 minutes). Surgeries with laser-assistance were on average 16 minutes shorter with a mean duration of 3 hours 26 minutes (± 45 minutes SD, range 2 hours 40 minutes to 4 hours 10 minutes). The difference was not statistically significant (P < 0.06). The mean value of aspirate volume for liposuctions performed without laser support was 2,618 mL (± 633.7 SD, range 700 mL to 3,500 mL). Mean aspirate volume for liposuctions with laser assistance was increased by up to 61 mL (2,677 mL ± 499.5 SD, range 1,800 mL to 3,500 mL). The difference was not statistically significant (P < 0.71).

CONCLUSION

We conclude that conventional liposuction and laser-assisted liposuction have a similar influence on platelets, lymphocytes, and neutrophils in patients. Moreover, laser-assisted liposuction seems to be less time consuming than conventional liposuction.

Metabolism modulators in sepsis: Propranolol

Sepsis is accompanied by an enormous increase in catecholamine expression, leading to metabolism of lipids and glucose, changes in cardiovascular output, immunomodulatory effects, and changes in protein metabolism, all of which push the body into a catabolic state. Deleterious beta-adrenoceptor controlled responses to stress and sepsis are well documented; therefore, it would seem appropriate to use propranolol under such circumstances. There are arguments both for and against the use of beta-adrenoceptor blockade during episodes of stress and infection. The definition of sepsis itself is a clinical one in most cases. There are guidelines concerning the diagnosis of sepsis (systemic inflammatory response syndrome [SIRS] in the presence of significant infection). However, when the cause of SIRS is not infection, for example, in burn patients, is it not possible, and indeed preferable, to tackle the stress response in a more aggressive fashion? The effects of SIRS on the body are myriad and have been defined and illustrated in many fine reviews. The effects of sepsis on the body, as well, have been discussed in the world literature and are beyond the scope of this article. In this article we attempt to demonstrate the effects of sepsis (SIRS plus infection) on whole body metabolism, outline the mediators of these changes, and then show the ability of propranolol to attenuate the changes seen.

The effects of anesthesia and surgery on count and function of neutrophils

The effects of anesthesia and surgery on neutrophil count, chemotaxis and neutrophil alkaline phosphatase (NAP) score were investigated in 10 patients who had elective spine surgery. Plasma levels of adrenaline, noradrenaline and cortisol were measured and correlations between hormonal levels and neutrophil count and function were assessed. Neutrophil count started increasing after the initiation of surgery, reached the highest level at 3 hours after surgery, and decreased gradually toward preanesthetic level on 3rd postoperative day. The increase in band cell: segment cell ratio is prominent, whereas lymphocytes decreased significantly. Neutrophil chemotaxis and spontaneous migration were increased significantly from the end of operation to 1st postoperative day. NAP score, assumed to reflect the neutrophil phagocytic activity, lowered transiently during anesthesia, then increased 1.6 times more than preanesthetic level on 1st postoperative day. It was indicated that the increased cortisol release rather than adrenaline due to body response to surgical stress might induce neutrophilia, and that the elective spine surgery might not be deleterious to the neutrophil function.

Diurnal variation of canine blood leukocyte counts

A diurnal variation was detected in the numbers of total leukocytes, neutrophils, lymphocytes and eosinophils in the blood of 19 dogs (10 beagles and nine German shepherds). Blood samples were collected every fourth hour for 24 hours and once a day for 7 days. The neutrophil count increased during the day and reached its maximum in the late afternoon. The lymphocyte count had its maximum values in the late evening and its minimum values in the early morning. The eosinophil numbers were low around noon, increased during the afternoon and reached their maximum numbers in the late evening. Leukocyte numbers had statistically significant diurnal variation, so in designing research protocols with repeated blood sampling and closely controlled factors it may be important to take blood samples at the same time every day. The mild normal leukocyte changes during the day are not likely to confuse interpretation of clinical cases where patient results are compared with wide reference ranges.

Epinephrine as a mediator of pulmonary neutrophil sequestration

Neutrophil-mediated lung injury is a potential complication of trauma and sepsis. Concomitant with trauma and sepsis, there is an immediate and sustained systemic elevation of catecholamines including epinephrine. In the absence of trauma or sepsis, we examined whether epinephrine contributes to the accumulation of neutrophils in the lung. Eight- to 12-week-old male CF-1 mice were injected i.p. with 0.2 mL of normal saline or epinephrine (0.1-5.0 mg/kg). An unmanipulated control group was included to examine the stress of i.p. injection. Animals were sacrificed at predetermined time points, and lung and spleen were harvested. PMN accumulation was assessed by using a myeloperoxidase (MPO) assay, which is an indirect marker for neutrophil presence. Morphometric analysis of lung tissue was performed by a pathologist blinded to the groups. Increasing epinephrine doses resulted in a significantly increased accumulation of pulmonary neutrophils compared with normal saline. The stress of normal saline injection also resulted in a significantly greater pulmonary neutrophil accumulation than unmanipulated controls. The effects of epinephrine on pulmonary neutrophil accumulation were greatest at 2 h, but they were not significantly different from saline-injected controls by 12 h. These results correlated with histological analysis. There were no significant differences in spleen MPO activity between groups, suggesting an organ-specific mechanism of epinephrine-induced pulmonary neutrophil sequestration. In the absence of trauma, shock, or infection, epinephrine results in the accumulation of neutrophils in murine lungs. The finding that "injection stress" increased lung neutrophil sequestration suggests the possibility that this mechanism may be physiologically relevant. Thus, epinephrine release in trauma may set the stage for development of neutrophil-mediated acute lung injury.

Effect of anti-asthmatic drugs on the response to inhaled endotoxin

BACKGROUND

Endotoxin is a pro-inflammatory agent contaminating the dust that has been associated with the risk to develop pulmonary diseases. There is no data on the protective efficacy of anti-asthmatic drugs on the response induced by inhaled endotoxin in human.

METHODS

Twelve mildly asthmatic subjects were submitted weekly to bronchial challenge tests with 20 microg endotoxin. The response was evaluated by the changes in FEV1, blood cells count, neutrophils activation (measured with the luminol-enhanced chemiluminescence) and blood concentration in the acute phase proteins, C-reactive protein (CRP) and haptoglobin. In a double-blind randomized cross-over placebo-controlled design, a single dose each of 500 microg beclomethasone dipropionate, 200 microg salbutamol, and 50 microg salmeterol were administered 30 minutes before the endotoxin challenge test.

RESULTS

The 20-microg endotoxin challenge test induced a significant decrease in FEV1 and luminol-enhanced chemiluminescence (P < .001 and <.05, respectively). There was an increase in the blood neutrophils count (P < .05), in CRP (P < .02) and in haptoglobin (P < .03) concentrations. Pretreatment with beclomethasone dipropionate did not have any significant effect on the response to inhaled endotoxin. Salbutamol and salmeterol completely prevent the FEV1 decline due to their potent bronchodilatation activity. Salmeterol and salbutamol did not have any significant effect on the blood inflammation induced by endotoxin inhalation.

CONCLUSION

The bronchodilating properties of beta2-agonists prevent the lung function response to inhaled endotoxin. When given in a single dose, an inhaled corticosteroid does not have protective activity on the endotoxin-induced blood inflammation.

Do peripheral blood counts have any prognostic value following trauma?

BACKGROUND

Both lymphocytosis and lymphopenia have been observed following trauma and each has been claimed to predict mortality. An understanding of the early temporal changes in leucocyte counts may help to explain why such discrepancies have been found. The purpose of this study was to determine the early serial changes in peripheral leucocyte counts following injury.

METHODS

A whole blood cell counter was used to measure serial total leucocyte, granulocyte, lymphocyte and monocyte counts from 20 patients in the first 3 h following blunt injury. Four to six peripheral blood samples were taken from each subject and grouped into 20 min intervals.

RESULTS

Granulocytosis, lymphocytosis and monocytosis were evident within 40 min of injury. A biphasic granulocyte and monocyte response was observed in the first 3 h following trauma. Lymphocytes showed a linear resolution towards normal (regression coefficient -0.022; p < 0.01) with some individuals developing a lymphopenia. No correlation with injury severity was observed.

CONCLUSION

Rapid mobilisation and subsequent redistribution of leucocytes occurs early following injury. Temporal changes will affect any predictive value of circulating leucocytes and studies must be precise with respect to blood sampling time.

Flow resistance of individual neutrophils in coronary artery disease: decreased pore transit times in acute myocardial infarction

OBJECTIVE

To investigate single neutrophil flow resistance in coronary artery disease, including myocardial infarction before initiation of reperfusion therapy.

DESIGN

Neutrophil flow resistance was measured in 93 subjects in five groups: (group 1) 28 patients within 12 hours after the onset of myocardial infarction, before reperfusion therapy; (group 2) 18 with unstable angina; (group 3) 13 with stable angina; (group 4) 13 age matched patients without coronary disease, and (group 5) 21 healthy volunteers. MAIN PARAMETERS: Single neutrophil transit times through 8 microns oligopore filters determined with a modified cell transit analyser.

RESULTS

Leucocyte count (10(9)/l) was increased in coronary disease, especially in myocardial infarction and unstable angina (mean and 95% confidence intervals for groups 1 to 5: 12.6 (11.0 to 14.2), 11.3 (8.5 to 14.1), 8.5 (7.4 to 9.6), 8.0 (6.0 to 10.0), 7.0 (6.1 to 7.9)). Polymorphonuclear granulocyte (PMN) flow resistance correlated negatively with white blood cell (WBC) count and was significantly decreased in coronary artery disease (CAD), especially in myocardial infarction; mean transit times (ms) for groups 1 to 5 were: 13.6 (11.8 to 15.4), 16.9 (13.9 to 19.0), 16.9 (12.8 to 21.0), 22.0 (19.6 to 24.4), and 18.6 (15.7 to 21.5).

CONCLUSION

Neutrophil flow resistance was decreased in CAD, especially in myocardial infarction before reperfusion therapy. In contrast to previous findings in reperfused myocardial infarction, the present study showed that stiffened PMNs were not yet present in the circulating blood pool. Thus a pharmacological approach aimed at suppressing leucocyte activation before or during reperfusion therapy may be feasible.

Neuroimmune modulation: signal transduction and catecholamines

In recent years, much interest has centered on the commonalities and bi-directional interactions between the nervous system and the immune system. This review focuses on mechanisms through which, catecholamines, a class of neuro-endocrine molecules, modulate immune functions. Catecholamines can be immune suppressive and inhibit lymphocyte activation of both T and B cells as well as the generation of immune-mediated anti-tumor responses. Some of these catecholamine-regulated activities appear to be modulated through the second messenger, cyclic AMP, whereas others appear to be catecholamine-dependent but cyclic AMP independent. Further delineation of the interacting ligand-receptor complexes, populations of responding cells and signal transduction mechanisms leading to the activation of specifically involved genes and gene products, will lead to enhanced understanding of the integratory functions of the nervous system in immune responses, the biology of stress, the role of stress-associated molecular mechanisms in perturbations of physiological homeostasis and the development of a new biological psychiatry with accompanying rational therapeutic modalities.

Modulation of non-specific immunity by hippocampal stimulation

Rats subjected to electrical stimulation of hippocampus (30 min/day for 4 days) showed an increase in the neutrophils in the peripheral blood when compared to sham (P < 0.01) and controls (P < 0.001). They also showed a significant decrease in lymphocytes, when compared to control rats (P < 0.001). Both sham and stimulated animals showed a significant decrease in total white blood cell count when compared to controls (P < 0.001). The phagocytic index of stimulated animals showed a significant increase from control (P < 0.001) and sham (P < 0.001). In addition, the stimulated animals showed a significant (P < 0.001) decrease in plasma corticosterone level when compared to sham and controls.

Are leucocyte-derived free radicals involved in ischaemia in human legs?

Leucocyte-derived free radicals were monitored in 30 stage II peripheral vascular disease (PVD) patients in an open placebo-controlled study. Linked to a transcutaneous oxygen pressure (TcPO2) monitor, they performed two consecutive standard treadmill tests (5 min, 2 km h-1, 12% slope) before and after 15-days treatment with placebo or a leucocyte-derived free radical scavenger (Piroxicam, 20 mg day-1), the second test being carried out at the TcPO2 half-recovery time. Blood samples were collected at baseline, at the maximum walking times and the TcPO2 half recovery times. The total and differential leucocyte counts, the percentage of cells with pseudopodia or cytoplasmatic irregularities, the filterability rates (using a positive pressure Nuclepore filter system) of the main leucocyte subfractions and plasma oxidant activity were monitored. Compared with values before treatment and with the placebo-treated group Piroxicam therapy significantly (P less than 0.001) reduced the final half-recovery time, the percentage of cells with pseudopodia and the level of plasma oxidant activity (P less than 0.01) and kept the granulocyte filterability rate stable, showing leucocyte-derived free radicals are involved in peripheral ischaemia.

Stable angina pectoris and controlled ischemia: what causes the abnormalities in whole blood filterability?

The determinants of the altered whole blood filterability observed during coronary ischemia are still under discussion. Since no studies have been carried out to date on what exactly causes these alterations during the early stages of controlled ischemia in coronary heart disease, a model was set up using a bicycle ergometer test (with a 25 W increase every 2 minutes). Blood samples were taken from 48 stable angina pectoris patients and from a group of 28 matched controls before and immediately after exercise and 8 minutes later. Plasma viscosity, the filterability (through 5 microns diameter pore filters) of whole blood, erythrocytes, and polymorphonuclear and mononuclear leukocytes (separated by density gradient) were monitored. Alterations in whole blood filterability could be linked only to an impairment in polymorphonuclear cell filterability in those stable angina pectoris patients who reported chest pain and/or whose ST segment depression was greater than or equal to 2 mm.

Leucocyte rheology in controlled coronary ischaemia

Since no studies have been carried out on the exact origin of the alterations in white blood cell rheology during the early stages of controlled ischaemia in coronary arterial disease, a model was set up using a cycle ergometer test (with a 25 watts increase every 2 minutes). Blood samples were taken (before and after exercise and again 8 minutes later at recovery) from 18 patients with stable angina pectoris and a group of 22 matched controls. The filterability (through 5 micrometer diameter pore filters) of the polymorphonuclear leucocyte sub-population (separated by density gradient), the monocyte and lymphocyte sub-fractions (separated by adhesion to Petri dishes) as well as leucocyte activation (observed under a light microscope) were monitored. Our results showed that the total leucocyte count in patients and controls rose after exercise and was accompanied by a differential shift from the polymorphonuclear to the lymphocyte cells. The polymorphonuclear filterability rate increased significantly in patients when compared to their basal values at rest, and to the controls after exercise (+ 19.58%; P less than 0.002 vs basal values at rest; + 18.72%; P less than 0.002 vs controls). This increase persisted throughout the recovery period (+ 19.86%; P less than 0.002 vs basal values; and + 23.52% P less than 0.001 vs controls), indicating that a reduced polymorphonuclear leucocyte filterability can be associated with the first signs of ischaemia.

Leucocyte behaviour in controlled ischaemia of the calves

Whole blood filterability and leucocyte behaviour (number, activation, and subfraction filterability rates) were monitored at the earliest stage of peripheral ischaemia in 18 patients with stage II peripheral occlusive arterial disease (PAOD) and 20 matched controls. A model of controlled ischaemia, using exercise to stress leg circulation, was set up and blood samples were taken before exercise, at the onset of calf pain, and at recovery from peak exercise. Leucocytes were counted, separated into their subfractions on a Ficoll-Hypaque density gradient and by adhesion to Petri dishes, and filtered in buffer (like the whole blood suspensions) through 5 microns pore diameter Nucleopore filters. Unfractionated white cells, separated under gravity, with pseudopodia or cytoplasmic irregularities were regarded as activated. The whole blood filterability rate was significantly increased at the onset of calf pain and was associated with significant increases in the number of leucocytes and in the filterability rate of the monocyte subfraction, the latter persisting throughout the recovery period. No significant changes were observed in the other variables monitored, showing that impairments in white cell rheology may be associated with ischaemia.

Human leucocyte rheology and tissue ischaemia

Reports suggest that white blood cells are involved in the development of tissue ischaemia. No studies on leucocyte rheology in the earliest stages of ischaemia exist. In 10 peripheral vascular disease (PVD) patients, 10 stable angina pectoris (SAP) patients and two groups of 10 matched controls leucocytes were separated by density and adherence into their granulocyte, lymphocyte and monocyte subpopulations. Blood samples were taken from the PVD group and respective controls before and after treadmill exercise (5 min 2 km-1 h-1, 12% slope) and from the SAP patients and controls before and after cycle ergometer test (25 W every 3 min). All the subpopulations were filtered through five micron diameter pore filters. Compared to controls, calf pain in the PVD patients was associated with an increase in monocyte filterability (P less than 0.01). ST depression in the SAP patients was linked to impaired granulocyte filterability (P less than 0.04). Therefore leucocyte rheology appears impaired in the earliest stages of ischaemia.

The leucocytosis of exercise. A review and model

Exercise is known to induce an immediate leucocytosis, the magnitude of which is related, in most instances, to the intensity and duration of the work. On finishing exercise, however, the leucocyte count may change in any one of several different ways. The pattern of postexercise changes in the leucocyte count is determined mainly by the time which has elapsed since beginning exercise, rather than the work intensity or the total work done, if, for example, exercise has been intermittent. Consideration of, firstly, the circumstances under which the plasma concentrations of catecholamines and cortisol have been found separately to correlate with the leucocyte count at the finish of exercise, and, secondly, the effects on the leucocyte count of exogenous administration of these substances has led us to develop a model which can satisfactorily account for all of the principal changes in the leucocyte count that have been noted during and after exercise. It is proposed that catecholamines produced during exercise act to increase the ratio of circulating to non-circulating leucocytes, while cortisol acts, by a mechanism which involves a time lag, to increase the total number of leucocytes in the vascular compartment. Examination of previously published reports shows that many contain results which support this model. Using the model as a basis, some predictions are made that can be tested experimentally, and some experiments are suggested which should help elucidate the mode of action of catecholamines and cortisol.

In vitro and in vivo analysis of the effects of recombinant human granulocyte colony-stimulating factor in patients

Twelve patients with small cell lung cancer were treated with recombinant human granulocyte colony-stimulating factor, rhG-CSF, given by continuous infusion at doses ranging from 1 to 40 micrograms kg-1 day-1. Patients received the rhG-CSF before the start of intensive chemotherapy and after alternate cycles of chemotherapy. Several in vitro assays were performed using peripheral blood neutrophils and marrow progenitor cells collected from patients prior to and after infusion of the growth factor. Peripheral blood neutrophils were tested for mobility and phagocytic activity. In addition, in vitro clonogenic assays of marrow haemopoietic progenitor cells and analysis of bone marrow trephines and aspirates were carried out. We found that rhG-CSF in vivo has at least two main effects: (a) an early fall in peripheral neutrophils, within the first hour, followed by a rapid influx of mature neutrophils into the circulatory pool; (b) stimulation of proliferation and differentiation of neutrophil precursors in the bone marrow. Neutrophils released into the circulation were normal in tests of their mobility and phagocytic activity.

The effect of lumbar puncture procedure on blood glucose level and leukocyte count in infants

Blood glucose level, urea concentration, and total white blood cell count were determined both before and 10-15 minutes after lumbar puncture (LP) procedure in 26 infants suspected of having meningitis. There was a significant (p less than 0.001) increase in the peripheral white blood cell (WBC) count (mean +/- standard deviation) from 10,960 +/- 3,500 cells/microliter before to 13,300 +/- 3,970 cells/microliter following the LP procedure, due to relative rise in the neutrophils and lymphocytes. Blood glucose levels did not change significantly following this procedure (85.3 +/- 13.4 mg/dl and 84.1 +/- 12.6 mg/dl respectively). An LP procedure does not impair correct cerebrospinal fluid glucose/blood glucose determination but may cause elevation of peripheral WBC count.

Effect of beta-adrenergic stimulation on the circulatory lymphocyte count: studies in normals and in patients with chronic airflow obstruction

In eight non-allergic patients with chronic airflow obstruction (CAO) and eight age and sex matched, healthy control subjects the circadian variation in circulatory lymphocyte count was studied in relation to serum cortisol and urinary epinephrine levels. In addition, we investigated the effect of the beta-adrenergic agent terbutaline on the lymphocyte count in two ways: as a long-term effect after 8 days of oral slow-release terbutaline with constant diurnal and nocturnal serum levels in patients, and as a short-term effect by a constant rate infusion of 0.2 micrograms/min over 4 hr in normals. Both patients and controls showed similar circadian patterns of urinary epinephrine excretion and lymphocyte counts. Patients with CAO, however, had significantly lower epinephrine levels and significantly higher lymphocyte counts at all hours of observation (every 4 hr from 0800 to 0800 hr the next day), as compared with normal controls. After 8 days of slow-release terbutaline the lymphocyte count in the patient group decreased to levels not significantly different from that of normals. The circadian rhythm of the lymphocytes, however, persisted under terbutaline therapy. No correlation existed between the lymphocyte count modulating factor, serum cortisol and the lymphocyte count over 24 hr. On placebo infusion in the control persons an increase of lymphocytes over 4 hr occurred, as a consequence of circadian rhythmicity. On terbutaline infusion a significant increase of lymphocytes after 1 hr was followed by a decrease to levels significantly below those on the placebo day. The same pattern was found in the leucocyte count. From this study it is concluded that beta-adrenergic stimulation corrects the relative lymphocytosis to counts comparable with normals. Other coinciding factors must regulate, however, the circadian rhythmicity.

Beta-adrenergic regulation of the blood lymphocyte phenotype distribution in normal subjects and splenectomized patients

The beta-adrenergic effect on the release of immunoregulatory cells from the spleen was investigated by physical stress testing (bicycle ergometry up to submaximal work capacity) in 19 normal subjects (15 males, median 21 years) and in 10 male patients splenectomized for trauma (median 29 years). It was repeated in 6 subjects of each group during beta-blockade with 80 mg oxprenolol. Blood samples for leucocyte analysis were taken before and at the end of the test. Leucocyte subpopulations were analyzed in a cytofluorograph after staining of buffy coat cells by direct (B cells) or indirect immunofluorescence with monoclonal antibodies directed against the phenotypes of T- (Leu-1), T helper- (Leu-3a), T suppressor/cytotoxic (Leu-2a) cells and natural killer (OKM1+ lymphocytes) cells. In the controls all leucocyte subsets increased at ergometry, but B-, Leu-2a- and OKM1-cells increased more than Leu-3a cells. During beta-blockade the leucocyte changes reached only 50% of the value without treatment; the B- and Leu-2a cell mobilization was reduced more than the Leu-3a-, OKM1 cell- and monocyte changes. In splenectomized patients the proportional cellular changes were only half of those found in normal subjects, except for the Leu-3a cells which were not released. Beta-blockade during ergometry had no effect on Leu-3a cells, a similar effect on B- and Leu-2a cells as in normal subjects and a stronger effect on granulocytes, monocytes and OKM1 cells than in controls. In conclusion, the B- and Leu-2a cell mobilization from the spleen (50%) was beta-adrenoceptor dependent, while the one from other lymphoid organs was beta-adrenoceptor independent. The strongly spleen dependent Leu-3a cell changes were not beta-adrenoceptor mediated. Granulocyte-, monocyte- and OKM1 cell changes were only partly spleen dependent. The spleen independent changes however were strongly beta-adrenoceptor dependent.

Lithium carbonate and granulocyte production: dose optimization

To determine the optimal dose of lithium for inducing granulocytosis, the authors administered lithium carbonate to normal volunteers at five dose levels. The authors performed assessments of circulating and marginated blood pools of granulocytes and of marrow reserve granulocytes to confirm that the early granulocytosis following lithium administration is due to increased granulocyte production rather than redistribution. At 300 mg/day and 600 mg/day, lithium had no significant effect on granulocyte production. Doses of 900, 1200, and 1500 mg/day, corresponding to lithium levels of 0.55 to 1.50 mEq/liter, were associated with increased granulocyte production. Within this therapeutic range, no correlation between lithium level and granulocyte production was demonstrated. This study suggests that any lithium dose which achieves a lithium level of greater than 0.55 mEq/liter, i.e., doses greater than or equal to 900 mg/day, is adequate to induce granulocytosis. While lithium did not increase platelet production, doses of 900 mg/day to 1500 mg/day were associated with decreased bleeding times.

Abnormal neutrophil chemotaxis in a syndrome of unusual facies, proportionate small stature and sensorineural deafness-mutism

Two of 5 children in one family presented with unique facies, proportionate small stature and sensorineural deafness-mutism. One of the children who had a history of recurrent infections, was shown to have a defect of leukocyte chemotaxis. Although impairment of chemotaxis could not be demonstrated in the other affected sibling, it is unlikely that the association of a previously undescribed syndrome and a rare disorder of chemotaxis is a chance occurrence.

Leukocyte mobilization by epinephrine and hydrocortisone in patients with chronic renal failure

The mobilization of WBC from the bone marrow, as judged from hydrocortisone-induced leucocytosis, is markedly impaired in dialyzed and nondialyzed uremic patients. The release of WBC from the marginal pool by epinephrine was found to be normal.

Circadian rhythm of stimulated lymphocyte blastogenesis. A 24 hour cycle in the mixed leukocyte culture reaction and with SKSD stimulation

The in vitro measurement of stimulated T lymphocyte blastogenesis by the incorporation of 14C-thymidine can be shown to be an acceptable and precise measurement with highly significant variations in blastogenesis over a 24 hr period. This circadian rhythm for human T lymphocyte blastogenesis has been demonstrated with specific antigen (SKSD) and in mixed leukocyte culture (MLC). The hours of peak reactivity were different for the SKSD stimulation and the MLC reaction. This biologic cycle in T cell reactivity has significant implications for the immunologic response.

Studies on the haematologic and cytogenetic effect of lithium

The corpuscular elements of the peripheral blod and the morphology and chromosome constitution of bone marrow cells have been studied in patients before and during lithium therapy as well as in patients who had received lithium for a substantial period. Lithium therapy produced elevated total white cell, granulocyte, eosinophil and thrombocyte counts and a lymphocytopenia, whereas no effect was seen on the erythrocyte and reticulocyte counts. There were no morphological or cytogenetic changes in the bone marrow aspirates. Neither were toxic doses of lithium able to produce chromosome abnormalities in rats.

Influence of adrenaline on the dissemination of antibody-producing cells from the spleen

Plaque-forming cells (PFC) and rosette-forming cells (RFC) were quantificated in splenic venous and splenic arterial blood and in spleen suspensions of guinea-pigs during a secondary immune response to sheep red blood cells (SRBC). The splenic veno-arterial differences in content of PFC and RFC were determined, indicating whether there had been a release of such cells from the spleen into the blood. The effect of an intracardial injection of adrenaline on the release of immune lymphocytes was investigated. In immunized control animals a splenic release of antigen-binding and antibody-forming cells was found, the release being restricted to the peak of the immune response in the spleen. However, after exogenous adrenaline a considerably increased release of both antigen-binding and antibody-forming cells occurred during a longer period of the immune response. Thus, adrenaline caused an enormous release of PFC from the spleen into the blood on day 4 of the secondary immune response, resulting in a diminished number of PFC remaining in the spleen after the treatment. A physiological significance of an adrenaline-induced dissemination of immune lymphocytes in the body during an immune response to a severe infectious disease is suggested.

Immune response in families of children with acute lymphoblastic leukaemia

The immune status of 33 mothers, 17 fathers, and 14 sibs of children with acute lymphoblastic leukaemia was studied with the following tests: peripheral blood lymphocyte counts, lymphocyte transformation with phytohaemagglutinin, serum immunoglobulin levels, isohaemagglutinin titres, and levels of antibody to herpes simplex and Epstein-Barr viruses. No significant abnormality was shown by these tests, with the exception of a lymphocytosis detected in parents at an early stage of their child's disease. The significance of these findings is discussed in the light of the concept that viral infection relates to the aetiology of childhood leukaemia. It is concluded that there is no defect of immunity in these families.