LEUKERGY IN MAJOR BURNS

Annals of the M.B.C. - vol. 1° - n° 2 - September 1988

LEUKERGY IN MAJOR BURNS

Tuchman I, Frid M., Ben-Hur N.E.

Shaare Zedek Medical Center - University affiliated teaching hospital - Jerusalem, Israel

SUMMARY. Leukergy, which consists of the appearance in the peripheral circulation of aggregates of leukocytes, was detected within a few hours in the case of major bums (at least 50% BSA). Leukergy leukocytes have greater mobility than normal leukocytes, their phagocytic activity is several times greater, and their adhesiveness is such that they cause agglomerates. The number of aggregates and the number of leukocytes present in each aggregate were directly proportional to the severity of the bum. In severe burn victims leukergy was often followed by ARDS. A lab model was performed with guinea pigs.

- Major Burns
- Leukergy
- ARDS
- Inappropriate answer of the WBC.

In major burns victims (50% BSA) we have noted the phenomenon of leukergy, which consists of the appearance in the peripheral circulation of aggregates of leukocytes.
Ludwig and Fleck in 195é mentioned this phenomenon as a result of sepsis which causes accelerated leukopoiesis supposedly of central origin which influences bone marrow leukopoiesis.
These leukocytes undergo a series of changes during their circulation:

1) the leukergy leukocytes have greater mobility than normal leukocytes;
2) they have phagocytic activity that exceeds several times that of normal leukoeytes;
3) adhesiveness: they tend to adhere one to another causing agglomeration of leukoeytes.

In inflammatory conditions they shift to the lung. This has particular importance in antibacterial defence mechanism since bacteria are trapped and phagocytized in small pulmonary vessels and are eliminated with phagocytes into the alveolar spaces.
The leukergy agglomerations of leukocytes cannot be seen as a serotopic response of the body or as a response to inflammatory conditions, as they appear in different situations, as stress responses to major burn in the immediate post bum hours.
We were able to find leukergy a few hours after bums have occurred in major bums (at least 50% BSA).
The number of aggregates and the number of leukocytes presenting in each aggregate were in direct proportion to the severity of the burn.
In severe burn victims we found a great amount of leukergy which appeared few hours before the appearance of ARDS.
We performed a lab model with guinea pigs. In this model we were able to show leukergy in peripheral blood, and in biopsies from the lung in which damage to the endothelium of the lung vessels with an interstitial enema similar to human ARDS was sighted. Guinea pigs weighing between 350 to 400 grins were subjected to third degree bums (40% BSA). Scalding was done after shaving their backs in water at a temperature of 70 V for 10 seconds.
They were anaesthetized with Pentothal.
The maximum response was noted after 3 hours.
The leukergy response in major burns and its accumulation in the lung is not yet understood.
It might be an inappropriate response of the WBC similar to the response of the platelets aggregation causing DIC while in a normal condition they aggregate to form a plug as a response to vascular damage.

RESUME La leukergie, qui consiste en I'apparition dans la circulation périphérique de grumeaux de leucocytes, se manifestait quelques heures aprés la lésion chez les grands brûlés (an moins 50% BSA). Les leucocytes de leukergie ont une plus grande mobilité que les leucocytes normaux, leur activité phagocytaire est nettement supérieure, et leur viscosité produit des grumeaux. Le nombre des grumeaux et le nombre des leucocytes présents dans chaque grumeau étaient directement proportionnels a la gravité de la brûlure. Chez les victimes de grandes brûlures, la leukergie se manifestait en plusieurs cas quelques heures avant Papparition de I'ARDS. On a procédé d une experimentation sur des cobayes.