cc654 CCJ Meeting abstract <p>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</p> Nanson JK Sheppard SV Kulkarni M Smith DC

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

 Critical Care <p>Autumn Scientific Meeting of the Association of Cardiothoracic Anaesthetists</p> Supported by an unrestricted educational grant from Bayer plc Meeting abstracts <p>Autumn Scientific Meeting of the Association of Cardiothoracic Anaesthetists</p> Glasgow, UK 19 November 1999 1364-8535 1999 4 Suppl A 3 10.1186/cc654 26 11 1999 23 12 1999 1999 Current Science Ltd cc-4-1-061-03

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).

<p>Table 1</p>

Mean total and activated white cell counts

NLDF control group

LG6 filter study group

Time (min)

Mean total WCC (range)

Activated WCC (range)

Mean total WCC (range)

Activated WCC (range)

0

684 (282–1155)

38 (1–328)

417 (253–531)

5 (2–8)

10

680 (260–1384)

37 (1–318)

351 (283–478)

4 (1–18)

20

767 (260–1684)

21 (2–152)

335 (222–526)

4 (0–20)

30

798 (305–1572)

54 (1–477)

294 (195–796)

5 (1–24)

40

900 (372–1802)

33 (2–266)

420 (302–709)

5 (1–20)

50

948 (277–1911)

50 (2–302)

490 (251–672)

7 (1–18)

60

969 (433–1707)

58 (2–351)

545 (403–740)

5 (0–14)

70

746 (500–1233)

11 (1–18)

587 (525–650)

7 (6–9)

80

662 (548–762)

12 (2–20)

541

6

90

847 (656–1038)

9 (5–12)

–

–

100

732

6

–

–

NLDF, nonleucocyte depleting filter; WCC, white cell count.

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.

 <p>Complement and the damaging effects of cardiopulmonary bypass.</p> Kirklin JK Westaby S Blackstone EH J Thorac Cardiovasc Surg 1983 86 845 857 6606084 <p>Depletion of neutrophils by filter during aortopulmonary bypass surgery transiently improve cardiorespiratory status.</p> Johnson D Thomson D Mycyk T Chest 1995 107 1253 1259 7750315 <p>Laboratory studies of the effect of Pall extracorporeal leucocyte filters LG6 and AV6 on patients undergoing coronary bypass grafts.</p> Thurlow PJ Doolan L Sharp R Perfusion 1996 11 29 37 8904324