Altered Lymphocyte Subsets During Cardiopulmonary Bypass

Abstract

Peripheral blood lymphocyte subsets were quantified by immunofluorescence in nine patients undergoing open heart surgery for coronary artery, valvular, and congenital heart disease. Compared with normal preoperative values, all patients developed an absolute lymphopenia, a reduction in T4 (helper) lymphocytes, and a statistically significant reversal of the T4/T8 ratio two hours after cardiopulmonary bypass (CPB). These changes could be caused by mechanical or immunogenic injury. A return to normal of the T4 subset and T4/T8 proportion occurred 24 hours after surgery. Whereas transient inactivation of immunoreactive lymphocyte clones may prevent unwanted immunization to blood products received during surgery, such temporary immune dysfunction could make certain patients liable to infectious sequelae. Viral-induced postperfusion syndromes, transmission of human T lymphotropic virus (HTLV) III by blood products, and reports of acquired immune deficiency syndrome after CPB foster a concern regarding postoperative infections under these circumstances.

Off-pump coronary artery bypass grafting does not reduce lymphocyte activation

“…This is in agreement with the hypothesis that lymphocyte activation, as an adaptive immune response, helps modulating the innate inflammatory response [13,29]. Therefore, lymphocyte activation after surgical trauma could be considered a desirable immune response [28].…”

“…In agreement with previous investigations [27], overall, our patients presented an early fall in T (CD3+) and B (CD19+) lymphocytes after surgery, which could be interpreted as immune depression and a potential increased risk for postoperative infection. Recently, it has been proposed that the changes in lymphocytes after surgery represent an active response, which could prevent exaggerated immune responses [17][18][19]28]. This is in agreement with the hypothesis that lymphocyte activation, as an adaptive immune response, helps modulating the innate inflammatory response [13,29].…”

Nosocomial infections during extracorporeal membrane oxygenation

“…Patients who were on bypass at our own institution for a short period of time but not placed on ECMO support had a much lower incidence of infection than ECMO patients (P < 0.001). Additionally, alteration of lymphocyte subsets as well as a decrease in peripheral blood natural killer cell activity and total B cell numbers have been described in patients requiring cardiopulmonary bypass [5,6,7,8]. These factors may also contribute to the development of nosocomial infections in patient requiring ECMO support.…”

Laboratory control values for CD4 and CD8 T lymphocytes. Implications for HIV-1 diagnosis

“…Among other diseases primary immunodeficiency [53.54], tubercuiosis [55]. early acute phases of viral infections such as influen;ia [56], Dengue fever [57] and even trauma [58] can aiso cause CD4 depiction.…”