Massive blood transfusion induces characteristic monocyte messenger RNA expression patterns in patients after multiple major trauma: a microarray pilot study

Abstract

Objective: Polymorphonuclear neutrophil (PMN) granulocytes play an important role in trauma, shock, and sepsis. In these acute illness situations, multiple parameters can be used to describe functional and structural changes of PMN granulocytes like, for example, cell count, multiple surface adhesion molecules, free radical oxygen production, activity of phagocytosis, and cytokine production. Nevertheless, up to now, in most of the daily clinical situations, only the general white blood cell count is used to receive information, ignoring the fact that the leukocyte-cell system is a mix of different complex cell-subsystems with totally different functions. Considering that complex systems show nonlinear behavior, we could expect heterogeneous reactions of PMN granulocytes to near-identical stimulations. Therefore, functional and structural parameters of this cell type were assessed during an ischemiareperfusion situation due to an identical extremity trauma impact. Material and Methods: Twenty male patients; elective anterior cruciate ligament reconstruction with tourniquet-induced ischemia; structural parameters: CD11b, CD16, CD18, CD62L, CD55, CD63, CD95; functional parameters: cell count, respiratory burst (free radical oxygen production) with and without stimulation by tumor necrosis factor, PMA, or fMLP. Analysis by fluorescence cytometry. Results: Each parameter showed uniformed changes in all patients. This could be interpreted as a homogenous reaction to homogenous stimulations. Nevertheless, in the analysis of all 20 patients intraindividually, it can be demonstrated that summarizing all functional and structural parameters each patient showed a total different pattern of PMN granulocyte reactions to a homogenous ischemia-reperfusion trauma. Conclusions: To describe cell behavior in acute illness situations, it is not adequate to use the routine, for example, white blood cell count. Even the analysis of single bhigh-techQ parameters can describe the principle change of the complex cell system only. It is necessary to analyze the pattern of cell behavior intraindividually to get deeper insights for a better understanding of reactions to, for example, trauma situations.