Morfometria e correlação clínico - laboratorial dos vacúolos em neutrófilos de pacientes com choque hemorrágico

Abstract

INTRODUCTION: Tissue trauma induces migration and activation of neutrophils through specific mediators. The process of apoptosis of neutrophils is essential to avoid the consequences of a systemic inflammatory response commonly seen after trauma. The formation of vacuoles in neutrophils seems to be a mechanism capable to attenuate the inflammatory response in patients victims of traumatic hemorrhagic shock. The aim of this work was to evaluate the number and size of cytoplasmic and nuclear vacuoles of May Grünwald-Giemsa stained neutrophils in peripheral blood smear obtained from trauma patients with hemorrhagic shock. METHODS: Seven sequential blood samples were collected from 20 patients with hemorrhagic shock and from 20 patients with trauma without hemorrhagic shock. The first sample was obtained just after the patient admission to the hospital followed by new samples collected at 6, 12, 18, 24, 48 and 72 hours, after collection of the first sample. Then blood smears were prepared and held morphometry of vacuoles hundred neutrophil collected each time the control group and shock group. The vacuoles nucleus and cytoplasm were counted and their area was measured using specific software. RESULTS: The number and area of vacuoles in neutrophil cytoplasm and nucleus from control group patients showed significant differences (p <0.05) when compared to the shock group ones. Lactic acid and heart rate parameters showed correlation with the number (r = 0.634) and the area (r = 0.624) of neutrophil cytoplasmic vacuoles as shown by multivariate analysis (p <0.05) CONCLUSION: Hemorrhagic shock induces greater vacuolization of neutrophils when compared to control group patients with mild trauma. Among the clinical and laboratory parameters evaluated, lactic acid and heart rate showed correlation with the number and area of neutrophil cytoplasmic vacuoles.