Cocks, Robert Anthony; (1994) The leucocytosis of trauma. Doctoral thesis (M.D), UCL (University College London).

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Abstract

The studies in this thesis have attempted to establish the existence of the leucocytosis of trauma, to clarify its features, and to examine its possible implications for the immune response. 110 patients were studied within three hours of moderate or major injury, and a significant difference (p < 0 .0001) established between their leucocyte counts and those of 110 normal controls. Differential leucocyte counts of 42 patients gave evidence of a very early neutrophilia and lymphocytosis. The neutrophilia was maximal at 3-4 hours post-injury and resolved slowly. The lymphocytosis resolved rapidly and was commonly replaced by lymphopenia. Serial phenotype studies of lymphocytes in 28 patients showed significant reductions (p<0.01) in total lymphocytes, CD4 and CD8 lymphocytes between blood samples taken less than 4 hours and 12-24 hours after injury. CD4 lymphocyte counts were low in 24 patients (85%), of which 6 (20%) were critically low (<0.25x10⁹/L). 22 patients (78%) also had low CD8 counts. Neutrophils of trauma patients exhibited reduced adhesion to nylon fibre when suspended in their own plasma, but not in tissue culture medium. Trauma plasma induced a reduction in adhesion of normal donor neutrophils, which was reversed by pre-incubation of the neutrophils with propranolol. The leucocytosis of trauma may therefore be due in part to reduced neutrophil adhesion induced by raised adrenaline levels. Studies of neutrophil microbicidal pathways within 6 hours of injury in 23 patients showed normal responses in 21 (91%). In 8 patients studied 8 hours or more after injury, only one (12.5%) had normal responses. Electron microscopic studies of neutrophils in 17 trauma patients showed no evidence of systemic degranulation within the first four hours after injury. Taken together, these results indicate the existence of a leucocytosis of trauma, which is composed of normal cell lines. Derangements of cell function appear after 4-8 hours, and the early post-trauma phase may offer the opportunity for development of therapies to avoid later sepsis and multiple organ failure.

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