Effects of anesthesia and operation on the classical pathway of complement activation

Lewis, Robert E.; Cruse, Julius M.; Richey, J V

doi:10.1016/0090-1229(82)90329-4

Cited by 18 publications

(5 citation statements)

References 5 publications

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“…In addition, we observed consumption of complement components during severe AHR, suggesting that complement may also contribute to the severity of anaphylaxis (61-63) by potentiating myeloid cell activation, in conjunction with PAF, histamine, and other mediators. This observation needs, however, to be confirmed in additional studies because a complement consumption could also be a consequence of general anesthesia (64).…”

Section: Discussionmentioning

confidence: 91%

An IgG-induced neutrophil activation pathway contributes to human drug-induced anaphylaxis

et al. 2019

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Anaphylaxis is a systemic acute hypersensitivity reaction that is considered to depend on allergen-specific immunoglobulin E (IgE) antibodies and histamine release by mast cells and basophils. Nevertheless, allergen-specific IgG antibodies have been proposed to contribute when the allergen is an abundant circulating large molecule, e.g., after infusions of therapeutic antibodies or dextran. Data from animal models demonstrate a pathway involving platelet-activating factor (PAF) release by monocytes/macrophages and neutrophils activated via their Fc gamma receptors (FcγRs). We hypothesized that such a pathway may also apply to small drugs and could be responsible for non–IgE-mediated anaphylaxis and influence anaphylaxis severity in humans. We prospectively conducted a multicentric study of 86 patients with suspected anaphylaxis to neuromuscular-blocking agents (NMBAs) during general anesthesia and 86 matched controls. We found that concentrations of anti-NMBA IgG and markers of FcγR activation, PAF release, and neutrophil activation correlated with anaphylaxis severity. Neutrophils underwent degranulation and NETosis early after anaphylaxis onset, and plasma-purified anti-NMBA IgG triggered neutrophil activation ex vivo in the presence of NMBA. Neutrophil activation could also be observed in patients lacking evidence of classical IgE-dependent anaphylaxis. This study supports the existence of an IgG-neutrophil pathway in human NMBA-induced anaphylaxis, which may aggravate anaphylaxis in combination with the IgE pathway or underlie anaphylaxis in the absence of specific IgE. These results reconcile clinical and experimental data on the role of antibody classes in anaphylaxis and could inform diagnostic approaches to NMBA-induced acute hypersensitivity reactions.

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Section: Discussionmentioning

confidence: 91%

An IgG-induced neutrophil activation pathway contributes to human drug-induced anaphylaxis

et al. 2019

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“…This fact indicates that the salvaged blood of patients with PNH continued to be lysed even after the wash process. Physical stresses, such as infections and surgery, can cause complement activation [7]. In addition, the unwashed salvaged blood contains increased levels of proinflammatory cytokines, such as interleukin-1β, 6, and 8, and activated complement components compared to the circulatory blood [8, 9].…”

Section: Discussionmentioning

confidence: 99%

Hemolytic reaction in the washed salvaged blood of a patient with paroxysmal nocturnal hemoglobinuria

et al. 2019

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Background In patients with paroxysmal nocturnal hemoglobinuria (PNH), the membrane-attack complex (MAC) formed on red blood cells (RBCs) causes hemolysis due to the patient’s own activated complement system by an infection, inflammation, or surgical stress. The efficacy of transfusion therapy for patients with PNH has been documented, but no studies have focused on the perioperative use of salvaged autologous blood in patients with PNH. Case presentation A 71-year-old man underwent total hip replacement surgery. An autologous blood salvage device was put in place due to the large bleeding volume and the existence of an irregular antibody. The potassium concentration in the transfer bag of salvaged RBCs after the wash process was high at 6.2 mmol/L, although the washing generally removes > 90% of the potassium from the blood. This may have been caused by continued hemolysis even after the wash process. Once activated, the complement in patients with PNH forms the MAC on the RBCs, and the hemolytic reaction may not be stopped even with RBC washing. Conclusions Packed RBCs, instead of salvaged autologous RBCs, should be used for transfusions in patients with PNH. The use of salvaged autologous RBCs in patients with PNH should be limited to critical situations, such as massive bleeding. Physicians should note that the hemolytic reaction may be present inside the transfer bag even after the wash process.

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“…It is now widely accepted that anaesthesia and surgical trauma result in immuno-suppression in both children and adults (20,21). Lewis et al reported that classical component pathway (C3) function was significantly reduced in patients undergoing anaesthesia and operation (22). Many reports on complement activation in adult patients associated with anaesthesia or surgery have been published (2, 15-1 7).…”

Section: Discussionmentioning

confidence: 99%

Perioperative complement activation in neonates under halothane or fentanyl anaesthesia

Mikawa

Maekawa

Goto

et al. 1992

Acta Anaesthesiol Scand

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We investigated perioperative changes in complement activation in 18 neonates undergoing elective abdominal surgery with or without thoracotomy by measuring plasma concentrations of C3a and C5a, and leucocyte counts in peripheral blood. The 18 neonates, ranging in age from 1 to 17 days, were randomly divided into two groups according to type of anaesthetic procedures; the "halothane group" consisted of nine neonates in whom general anaesthesia was maintained with halothane and nitrous oxide (N2O) in oxygen, while the "fentanyl group" consisted of nine neonates in whom general anaesthesia was maintained with fentanyl and N2O in oxygen. Plasma C3a and C5a concentrations were higher in the fentanyl group than in the halothane group during the perioperative period. We have demonstrated that abdominal surgical trauma caused complement activation even in neonates undergoing the fentanyl rather than the halothane anaesthesia. Further studies are required to elucidate the precise mechanisms and the clinical implication of perioperative complement activation in neonates.

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Effects of anesthesia and operation on the classical pathway of complement activation

Cited by 18 publications

References 5 publications

An IgG-induced neutrophil activation pathway contributes to human drug-induced anaphylaxis

An IgG-induced neutrophil activation pathway contributes to human drug-induced anaphylaxis

Hemolytic reaction in the washed salvaged blood of a patient with paroxysmal nocturnal hemoglobinuria

Perioperative complement activation in neonates under halothane or fentanyl anaesthesia

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