2017, Number 2
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Rev Hematol Mex 2017; 18 (2)
Effect of deleterious alterations of anemia on human immunoregulation
Gallardo-García MB, Gallardo-Pedrajas F, Cabra-Bellido MJ, Sánchez-Gallegos P
Language: Spanish
References: 24
Page: 68-84
PDF size: 401.53 Kb.
ABSTRACT
Background: Ferropenic anemias are very common in severe patients, as well as hospital malnutrition.
Objetives: To study lymphopenia, lymphocyte subpopulations and immunoglobulins in severe anemic patients.
Patients and Method: A prospective study was done during 2007 including anemic patients after their baseline process (tumoral disease, surgery or severe septic). We assessed anemia (hemoglobin, sideremia, transferrin and ferritin) and the immunological situation: Complete blood count, total lymphocytes and quantification of the lymphocytic subpopulations, referred to T cells, CD3, CD4, CD8, B cells (CD19) and NK cytolytic cells (CD16/CD56) and levels of IgA, IgG, IgM. Patients were compared with a control group after being subjected to diagnostic and/or therapeutic test with a high risk of life-threatening, from cardiology (cardiac catheterizations, hemodynamic studies), neurology, therapeutic and emergency arteriography.
Results: There were included 34 patients in the control group, 22 due to tumoral disease and 12 due to severe sepsis. Control group included 36 patients who presented normal values of their blood count, including total leukocytes and lymphocytes and iron metabolism. Patients with cancer and septic had anemia, hipoferremia and high levels of serum ferritin, more pronounced in the septic patients group. There were very marked lymphopenia in both groups of patients, but in the study of T cells, were lower in septic patients. The CD4/CD8 ratio was normal in both groups. In terms of B cells, there was an increase, more in septic patients and there were no modifications in NK cytolytic cells. There were found low IgG serum levels, although B lymphocyte expression was increased.
Conclusions: Anemic patients post cancer and septic showed severe lymphopenias and alterations of their lymphocyte populations. The decrease and functional alterations of T lymphocytes, increase of the B lymphocytes and normality of the NK cells cytolytic were more observed in septic patients. There were low levels of IgG, although expression of B cells in both groups was increased.
REFERENCES
DeAngelo A, Bell D, Quinn M, Ebert Long D, Ouellette D. Erythropoietin response in critically ill mechanically ventilated patients: A prospective observational study. Crit Care 2005;9:R172-R176.
Achaean M, Mari P. Anaemia, allogenic blood transfusion and immunomodulation in the critically ill. Chest 2005;127:295-307.
Ouellete D. The impact of anaemia in patients with respiratory failure. Chest, 2005;128:576-582.
Piagnerelli M, Vincent JL. Role of iron in anaemic critically ill patients: It’s time to investigate! Crit Care 2004;8:306-307.
Pieracci F, Barie P. Diagnosis and management of iron-related anaemia’s in critical illness. Crit Care Med 2006;34:1-8.
Gallardo F, Gallardo MB, Cabra MJ, Curiel E y col. Nutrición y anemias en pacientes graves. Nutrición hospitalaria 2010;25(1):99-106.
Gallardo García MB. Fisiopatología del metabolismo del hierro y su repercusión clínica. Alteraciones hematológicas, inmunológicas y nutricionales que ocasionan enfermedades humanas. Editorial Académico Española, 2015. ISBN: 978-3-659-09407-1.
Patteril MV, Davey-Quinn AP, Gedney JA, Murdoch SD, Bellamy M. Functional iron deficiency, infection and systemic inflammatory response syndrome in critical illness. Anaesth Intensive Care 2001;29:473-478.
Darveau M, Denault A, Blais N, Notebaert E. Bench-tobedside review: Iron metabolism in critically patients. Crit Care 2004;8:356-362.
Brock JH. Benefits and dangers of iron during infection. Clin Nutr Metabol Care 1999;2:507-510.
Culebras-Fernández JM, de Paz Arias R, Jorquera-Plaza F, García de Lorenzo A. Nutrición en el paciente quirúrgico: Inmunonutrición. Nutr Hosp 2001;16:67-77.
Lapointe M. Iron supplementation in the intensive care unit: When, how much, and by what route? Crit Care 2004;8:S37-S41.
Corwin H, Krantz S. Anaemia of the critically ill. “Acute” anaemia of chronic disease. Crit Care Med 2001;29:S199- 200.
Madrigal G, Moreno C, Rubio V, Ibáñez G, López S, Martínez G. Respuesta al estrés prequirúrgico en la cirugía sin ingreso: Efectos sobre las poblaciones linfocitarias de un procedimiento de psicoprofilaxis quirúrgica. Rev. Esp Anestesiol Reanim 2005;52:383-388.
Ogawa K, Hirai M, Katsube T, Murayama M, Hamaguchi K, Shimakawa T, et al. Suppression of cellular immunity by surgical stress. Surgery 2000;127:329-336.
Weiss G, Goodnough L. Anaemia of chronic disease. N Engl J Med 2005;352:1011-1023.
Ba VN, Bota DP, Melot C, Mscibiosta V, Vincent JL. Time course of haemoglobin concentrations in nonbleeding intensive care unit patients. Crit Care Med 2003;31:406-410.
Gabay C, Kushner I. Acute-phase proteins and other systemic response to inflammation. N Engl J Med 1999;340:448- 454.
Gallardo F, Gallardo MB, Cabra MJ, Ramírez G, Barón JJ, Prieto MA. Alteraciones del metabolismo del hierro y anemia en pacientes críticos. Anemia 2009;2(3):97-102.
Von Ahsen N, Muller C, Serhe S, Frei U, Eckardt KU. Important role of nondiagnostic blood loss and blunted erythropoietic response in the anaemia of medical intensive care patients. Crit Care Med 2001;29:S141-S150.
Rudis M, Jacobi J, Hassan E, Dasta, J. Managing anaemia in the critically ill patient. Pharmacotherapy 2004;24:229- 247.
Bellamy MC, Gedney JA. Unrecognised iron deficiency in critical illness. Lancet 1998;352:1903.
Gallardo MB, Gallardo F, Cabra MJ, Sánchez P, Bondia JA. Alternativas terapéuticas a las transfusiones de sangre en pacientes graves. Rev Hematol Mex 2012;13:153-164.
Guimond M, Fry T, Mackall C. Cytokine signals in T-cell homeostasis. J Immunother 2005;28:289-294.