1040 ACUTE CHANGES IN CIRCULATING LYMPHOCYTE SUBSETS AND FUNCTION FOLLOWING SPLENECTOMY IN BETA THALASSEMIA MAJOR

Abstract

In a prospective study of 23 children with Thalassemia Major we demonstrated a 3 fold increase in circulating B cells, and decreased lymphoproliferative responses to PHA and Candida albicans in nonsplenectomized patients of whom 92% were anergic. Splenectomized patients, however, had a 10 fold increase in B cells, as well as a 2 fold increase in T4 and T8 positive cells. This group was not anergic, and had higher in vitro responses to Candida albicans. We hypothesized that the difference between these two groups was related to splenectomy rather than the stage of the disease and/or its treatment. To test this, two patients have been followed prospectively. In comparison to their pre-splenectomy data, there was a 1½ and 5 fold increase in circulating number of B cells and a 2 and 3 fold increase in T cells and a marked increase in lymphocyte responses to Candida albicans and allogeneic lymphocytes. A 2 fold increase in circulating HLA-DR positive cells was noted. 92%. were B cells, less than 1% T cells. The mononuclear spleen cells were not as suppressive as the patient's peripheral blood lymphocytes. Peripheral blood lymphocytes from patients were more suppressive than were control lymphocytes. These observations suggest (1) splenectomy is the cause of the increased number of circulating T and B lymphocytes, (2) the elevation in lymphocytes is secondary to redistribution rather than activation (3)increase lymphocyte response is due to a loss of suppressor cells atsplenectcomy.

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