Dysfunction of humoral immunity in anergic surgical patients: absence of anti-tetanus IgG antibody production

Detrimental effects of perioperative blood transfusion

Evidence suggests that perioperative allogeneic blood transfusion increases the risk of infectious complications after major surgery and of cancer recurrence after curative operation. This has been attributed to immunosuppression. Several authors have suggested that filtered whole blood and/or red cell concentrate, or leucocyte- and buffy coat-reduced red cells in artificial medium or their own plasma, may reduce postoperative immunosuppression. It was also anticipated that the use of autologous blood might minimize the risk of perioperative transfusion, but studies have unexpectedly shown similar postoperative infectious complications and cancer recurrence and/or survival rates in patients receiving autologous blood donated before operation and those receiving allogeneic blood. Future studies should identify common risk factors associated with blood storage.

In vivo and in vitro humoral immunity in surgical patients

In vivo and in vitro humoral immunity was studied in surgical patients. Laboratory controls (LC), delayed type hypersensitivity (DTH) skin test reactive (HR), and anergic (HA) patients were immunized with tetanus toxoid. Maximum in vivo antibody levels occurred 14 days after immunization. Eighty-six, 47, and 17% of LC, HR, and HA subjects, respectively, showed a positive response (X2(2) = 21.1 with Yates, p less than 0.0005). Peak in vitro antibody production in unstimulated lymphocyte cultures occurred at day 6 after immunization. Antibody responses in vitro were reduced in all surgical patients, worst in HA, and correlated quantitatively with in vivo antibody responses at day 14 (Spearman rank correlation = 0.794, p less than 0.001). Total IgG production in vitro was not decreased; 595, 1080, and 1538 ng IgG/culture were produced by LC, HR, and HA, respectively. These data demonstrate decreased in vivo and in vitro humoral immunity in all surgical patients, worst in those with decreased DTH responses. There is a kinetic and quantitative correlation between in vivo and in vitro responses, the latter being a biologic reflection of the integrity and magnitude of the in vivo process. Finally, failure to produce specific antibody is not due to failure of total IgG synthesis.

Evaluation of test immunisation in the assessment of antibody deficiency syndromes

Antibody responses after immunisation with pneumococcal polysaccharide did not correlate with the severity and frequency of infections in 22 patients with severe hypogammaglobulinaemia, when these were measured by a Farr radioimmunoassay. Five "healthy" patients with severe hypogammaglobulinaemia not only failed to make antipneumococcal polysaccharide antibody, when measured by radioimmunoassay, but also had very low or unrecordable antibody responses to Escherichia coli and failed to produce antibody when immunised with tetanus toxoid. Some of these subjects, however, did make small amounts of IgM antipneumococcal polysaccharide antibody when this was measured by an enzyme linked immunosorbent assay, while others retained some ability to produce IgM or IgA or both in their saliva. These findings show that the measurement of serum antibody responses after immunisation, with the possible exception of IgM antibodies to polysaccharides, is unlikely to be helpful in assessing the requirement for gammaglobulin replacement therapy in patients with hypogammaglobulinaemia.