A comparison of sequential total and activated white cell count in patients undergoing coronary artery bypass grafting, using cardiopulmonary bypass, with and without a white cell filter

JK Nanson, SV Sheppard, M Kulkarni and DC Smith

Shackleton Department of Anaesthetics, Southampton General Hospital, Southampton, UK

from Autumn Scientific Meeting of the Association of Cardiothoracic Anaesthetists
Glasgow, UK. 19 November 1999

Critical Care 1999, 4(Suppl A):3doi:10.1186/cc654

Received:	26 November 1999
Published:	23 December 1999

Introduction

Cardiopulmonary bypass (CPB) has been shown to induce a systemic inflammatory response similar to the local reaction seen after tissue damage [1]. This leads to the release of toxic substances, such as elastase, which cause endothelial damage and may adversely affect outcome [2]. Use of a leucocyte depleting arterial line filter is one of many anti-inflammatory strategies that are undergoing evaluation. Leucocyte depleting filters may be capable of selectively removing activated white cells [3], but this has not been proved in vivo. The aim of the present study was to compare sequential total and activated white cells during CPB, using either a leucocyte depleting or standard arterial line filter.

Materials and methods

After local ethical committee approval, 20 patients undergoing coronary artery bypass grafting using CPB were prospectively randomly allocated to have either a Leukogard LG–6 (Pall Biomedical, Portsmouth, UK) or a nonleucocyte depleting filter inserted into the arterial line of the CPB circuit. Arterial limb blood samples were taken immediately after institution of CPB (0min) and at 10–min intervals throughout the bypass period. Activated white cells were identified using nitroblue tetrazolium, then both total and activated white cell numbers counted after staining with Leucoplate.

Results

Table 1 shows the number of white cells counted/1.25 μ l (volume of a single channel of Nageotte counting chamber) using light microscopy (× 25).

Table 1. Mean total and activated white cell counts

Conclusion

The LG6 leucocyte filter reduces the total white cell count and is capable of selectively removing activated white cells during CPB. The exact relationship between leucocyte depletion and improved patient outcome still remains unclear.

References

Kirklin JK, Westaby S, Blackstone EH, et al.: Complement and the damaging effects of cardiopulmonary bypass.
J Thorac Cardiovasc Surg 1983, 86:845-857. PubMed Abstract
Johnson D, Thomson D, Mycyk T, et al.: Depletion of neutrophils by filter during aortopulmonary bypass surgery transiently improve cardiorespiratory status.
Chest 1995, 107:1253-1259. PubMed Abstract | Publisher Full Text
Thurlow PJ, Doolan L, Sharp R, et al.: Laboratory studies of the effect of Pall extracorporeal leucocyte filters LG6 and AV6 on patients undergoing coronary bypass grafts.
Perfusion 1996, 11:29-37. PubMed Abstract

This article is part of the supplement: Autumn Scientific Meeting of the Association of Cardiothoracic Anaesthetists