Papers by Anders Bengtsson
Pathophysiology of Shock, Sepsis, and Organ Failure, 1993
The bactericidal effect of blood has been known for more than 100 years [1, 2]. As early as the l... more The bactericidal effect of blood has been known for more than 100 years [1, 2]. As early as the late nineteenth century it was demonstrated that serum contains factors that mediate lysis of bacteria and antibody sensitized cells [3]. Complement is an essential system for protection against invading microorganisms like virus and bacteria. Split products of this cascade will enhance phagocytosis, bacterial killing and promote leukocytosis [4, 5]. Lysis of foreign invaders by complement requires components C5b-C9 from the terminal part of the complement cascade. This complex is also called the membrane attack complex [6]. Individuals with different hereditary complement protein defects suffer from recurrent and sometimes life threatening infections [7–9].
World Journal of Surgery, 1992
Thermal injury is associated with altered immune defense. Extensive and deep thermal injuries lea... more Thermal injury is associated with altered immune defense. Extensive and deep thermal injuries lead to depressed immune defense function with both cellular and humoral defense affected. There is an intricate interaction hetween various components of the immune system. The altered specific immune response is seen as a depressed ability to produce active rosette-forming cells. Depressed stimulation of lymphocyte proliferation as well as the mixed lymphocyte response have also been recorded following burns. These effects are modulated by the release of kinins, prostaglandins, anaphylatoxins, superoxides, and leukotrienes, all of Which can influence the inflammatory response following thermal injury. The humoral immunity is altered as seen by decreased levels of immunoglobulins, activation of complement with release of anaphylatoxins, and formation of membrane attacking complexes leading to inflammation and cytolysis. The immune response to burns is also affected by factors other than this injury, such as nutrition or diseases such as diabetes mellitus or disorders of the iymphoproliferative type. The immune response is also influenced by some drugs used for other reasons such as steroids, chemotherapeutic agents, and topical agents used for burn wound care. The immune reaction to a burn is also influenced by the additive effect of SUperimposed infections. Removal of injured tissue without the need for extensive transfusion will improve the ability of the burned patients to use their immune defense system in a fruitful way.
Intensive Care Medicine, 2006
Objective: The aim of this study was to evaluate the correlation between sympathetic nervous acti... more Objective: The aim of this study was to evaluate the correlation between sympathetic nervous activation and the immune response in patients following subarachnoid haemorrhage (SAH). Design and setting: Clinical study in a neurosurgical intensive care unit. Patients and participants: Fourteen patients with acute non-traumatic SAH were included. Fifteen healthy, agematched volunteers served as controls for measurement of catecholamine spillover. Intervention: Blood sampling for C3a, C5b-9, IL-6, IL-8 and norepinephrine kinetic determination was made within 48 h, at 72 h and on the 7th-10th day after the SAH. Measurements and results: SAH patients exhibited a profound increase in the rate of norepinephrine spillover to plasma at 48 h, 72 h and 7-10 days after the insult, 3-4 times that in healthy individuals. The plasma levels of C3a, IL-6 and C5b-9 were significantly elevated at 48 h, at 72 h and 7-10 days after the SAH, but the plasma level of IL-6 decreased significantly 7-10 days after the SAH. There was no relationship between the magnitude of sympathetic activation and the levels of inflammatory markers. Conclusions: Following SAH a pronounced activation of the sympathetic nervous system and the inflammatory system occurs. The lack of significant association between the rate of spillover of norepinephrine to plasma and the plasma levels of inflammatory markers indicates that the two processes, sympathetic activation and the immune response, following SAH are not quantitatively linked. In spite of a persistent high level of sympathetic activation the plasma level of IL-6 decreased significantly one week after SAH.
European Journal of Pediatrics, 1996
Premature children (n = 25) with respiratory distress (RD) were studied regarding complement acti... more Premature children (n = 25) with respiratory distress (RD) were studied regarding complement activation and formation of the anaphylatoxins C3a and C5a. Blood samples were drawn on admission to the paediatric intensive care unit. In 18 of the patients RD was accompanied by other perinatal complications like pneumothorax or intracerebral haemorrhages. Seven of the premature children had RD without such complications. Preterm children with RD and with peri-and postnatal complications such as pneumothorax or intracerebral haemorrhage had increased concentrations in plasma of the anaphylatoxins C3a and C5a compared with preterm children with RD without these complications. There was a positive correlation be-tween the plasma C3a and C5a concentrations in the preterm children. The present study indicates that isolated RD wilt appear without signs of complement activation and that complications like pneumothorax or intracerebral haemorrhages are associated with release of the anaphytatoxins C3a and C5a,
Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 2001
To determine whether salvaged autologous blood collected postoperatively contains complement spli... more To determine whether salvaged autologous blood collected postoperatively contains complement split products (SC5b-9), and pro-inflammatory cytokines (IL-6 and IL-8) and whether there are any differences between blood collected during hip or knee surgery. Methods: Fifty-eight consecutive patients undergoing hip or knee replacement surgery were studied. Thirty-eight had postoperative bleeding large enough to require infusion of salvaged blood. The salvaged blood was filtered during collection through a 200 µm filter and before infusion a 40 µm filter was used. Samples for complement and cytokine determinations were drawn from the circulation and from the collected blood. Results: High concentrations of SC5b-9, IL-6, and IL-8 were found in salvaged blood. The concentrations were higher than in the circulation (P < 0.05). The circulating concentrations of IL-6 and IL-8 were increased 60 min and 12-18 hr after transfusion. There were no differences regarding SC5b-9, IL-6, and IL-8 in the blood collected after hip or knee surgery. Blood collected from a surgical wound contains large concentrations of inflammatory mediators. There were no differences between blood collected during hip or knee surgery. Objectif : Déterminer si la récupération postopératoire de sang autologue contient des produits de dégradation du complément (SC5b-9) et des cytokines pro-inflammatoires (IL-6 et IL-8), et s'il y a des différences avec le sang prélevé pendant l'opération de la hanche ou du genou. Méthode : L'étude a porté sur 58 patients successivement admis pour la mise en place d'une prothèse de hanche ou du genou. Chez 38 d'entre eux, les pertes sanguines postopératoires ont été assez importantes pour nécessiter la transfusion de sang récupéré. Ce sang a été filtré pendant le prélèvement avec un filtre de 200 µm et avant la transfusion avec un filtre de 40 µm. Des échantillons retenus de la circulation et du sang récupéré ont servi à déterminer la cytokine et le complément. Résultats : De fortes concentrations de SC5b-9, IL-6 et IL-8 ont été trouvées dans le sang récupéré. Elles étaient plus élevées que celles de la circulation ( P < 0,05). Les concentrations circulantes de IL-6 et de IL-8 ont augmenté 60 min et 12-18 h après la transfusion. Aucune différence n'a été enregistrée concernant les SC5b-9, IL-6 et IL-8 dans le sang prélevé après l'opération de hanche ou du genou. Le sang prélevé au site d'incision chirurgicale contient de grandes concentrations de médiateurs de l'inflammation. Ce sang ne présente pas de différence avec celui qui est prélevé pendant une opération de hanche ou du genou.
European Journal of Cardio-Thoracic Surgery, 2013
The inflammatory response after cardiac surgery is characterized by a profound release of pro-and... more The inflammatory response after cardiac surgery is characterized by a profound release of pro-and anti-inflammatory cytokines. Recent data suggest that the balance between pro-and anti-inflammatory cytokines is of greater importance than the absolute levels. Retransfusion of unwashed cardiotomy suction blood contributes to the inflammatory response, but the balance between pro-and anti-inflammatory cytokines in cardiotomy suction blood and whether cell salvage before retransfusion influences the systemic balance have not been investigated previously. Twenty-five coronary artery bypass grafting patients were randomized to either cell salvage of cardiotomy suction blood or no cell salvage before retransfusion. Plasma levels of three anti-inflammatory cytokines [interleukin (IL)-1 receptor antagonist, IL-4 and IL-10] and two proinflammatory cytokines (tumour necrosis factor-alpha and IL-6), and the IL-6-to-IL-10 ratio was measured in cardiotomy suction blood before and after cell salvage, and in the systemic circulation before, during and after surgery. Plasma levels of all cytokines except IL-4 and IL-10 were significantly higher in cardiotomy suction blood than in the systemic circulation. The IL-6-to-IL-10 ratio was 6-fold higher in cardiotomy suction blood than in the systemic circulation [median 10.2 (range 1.1-75) vs 1.7 (0.2-24), P < 0.001]. Cell salvage reduced plasma levels of cytokines in cardiotomy suction blood and improved the systemic IL-6-to-IL-10 ratio 24 h after surgery [median 5.2 (3.6-17) vs 12.4 (4.9-31)] compared with no cell salvage (P = 0.032). The balance of pro-and anti-inflammatory cytokines in cardiotomy suction blood is unfavourable. Cell salvage reduces the absolute levels of both pro-and anti-inflammatory cytokines in cardiotomy suction blood and improves the balance in the systemic circulation after surgery.
The Annals of Thoracic Surgery, 2004
Background. Cardiotomy suction and autotransfusion of mediastinal shed blood may contribute to th... more Background. Cardiotomy suction and autotransfusion of mediastinal shed blood may contribute to the inflammatory response after cardiac surgery. We compared inflammatory activation, myocardial injury, bleeding, and hemoglobin levels in patients undergoing coronary surgery with or without retransfusion of cardiotomy suction blood and mediastinal shed blood. Methods. Twenty-nine patients were included in a prospective randomized study. Cardiotomy suction blood and mediastinal shed blood were either retransfused or discarded. Plasma concentrations of the cytokines tumor necrosis factor-␣ and interleukin-6 and complement factor C3a were measured preoperatively and 10 minutes, 2 hours, and 24 hours after cardiopulmonary bypass. C-reactive protein, erythrocyte sedimentation rate, troponin-T, and hemoglobin levels were analyzed preoperatively, and 24 and 48 hours after cardiopulmonary bypass. Postoperative bleeding the first 12 hours was registered. Results. Baseline data did not differ between the groups. Plasma concentrations of tumor necrosis factor-␣, interleukin-6, and C3a increased after surgery in both groups but significantly less in the group without cardiotomy suction and autotransfusion. The peak delta values in the no-retransfusion group was 36% (tumor necrosis factor-␣), 47% (interleukin-6), and 75% (C3a) of the values in the retransfusion group. C-reactive protein, erythrocyte sedimentation rate, and troponin-T increased after surgery in both groups without intergroup differences. Postoperative bleeding and hemoglobin levels did not differ between the groups. No patient received homologous blood transfusion. Conclusions. Coronary surgery without retransfusion of cardiotomy suction blood and mediastinal shed blood reduces the postoperative systemic inflammatory response.
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Papers by Anders Bengtsson