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Richard J. Howard, MD, PhD; Corey Crain, MD; Daisy A. Franzini, MD; C. Ian Hood, MD; Tony E. Hugli, PhD

Arch Surg. 1988;123(12):1496-1501.

Abstract
• We measured white blood cell counts and complement component (C3a, C4a, and C5a) and prostacyclin levels, and studied lung biopsy specimens, in 16 patients undergoing cardiopulmonary bypass and compared them with four patients undergoing other pulmonary procedures. Bypass caused no significant elevation in peripheral venous white blood cell counts. Higher counts were present in the right atrium compared with the left atrium. Patients who underwent bypass had elevated complement component and prostacyclin concentrations before operation and these levels increased further during operation. Trapping of polymorphonuclear leukocytes occurred in pulmonary alveolar capillaries and venules after bypass. We conclude that bypass activates complement components primarily of the alternative pathway and leads to increased blood prostacyclin levels. These changes are accompanied by polymorphonuclear leukocyte accumulation in the lungs and may be important in initiation of the adult respiratory distress syndrome in these patients.

(Arch Surg 1988;123:1496-1501)

Author Affiliations
From the Departments of Surgery (Drs Howard and Crain) and Pathology (Drs Franzini and Hood), University of Florida, College of Medicine, Gainesville, and the Gainesville Veterans Administration Hospital; and the Department of Immunology, Scripps Clinic and Research Foundation, La Jolla, Calif (Dr Hugh).

Footnotes
Accepted for publication July 18, 1988.

Read before the Eighth Annual Meeting of the Surgical Infection Society, San Francisco, May 6, 1988.

Reprint requests to the Department of Surgery, Box J-286, J. H. Miller Health Sciences Center, University of Florida, College of Medicine, Gainesville, FL 32610 (Dr Howard).

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