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DCS and the Immune System

The link between DCS and the immune system still isn’t well understood in diving medicine; although numerous scientific studies have shown that a link probably exists.

Bubbles during DCS and the immune system

Dive medicine research has shown that decompression-related bubbles formed within the body on ascent will trigger an immune system response. For this reason, immune-suppressant drugs are often administered during hyperbaric treatment for decompression sickness.

The immune response

The immune system reacts to bubbles as it would to any foreign body; such as a virus or bacteria. That reaction is as follows:

When bubbles occur in the body they will attract blood proteins, as those proteins make contact with bubbles they change in molecular shape and solubility (denaturation).

The denatured protein is recognized by the body and the body diverts white blood cells to ‘attack’ the bubble, whilst also releasing histamines to dilate blood vessels in the area (local inflammation) that aids the travel of the white blood cells to where they are needed.

The release of histamine also causes the surrounding blood vessel lining to become sticky so that white blood cells surrounding the bubble will ‘stick’ in place and trap the bubble. This process is known as margination.

The process of margination also causes cells in the blood vessel wall (endothelium cells) to separate and allow fluids, white blood cells and the bubble/s to leave the bloodstream and enter the surrounding tissues.  This not only thickens the blood, but a sufficient loss of fluid from the bloodstream into the tissues can cause shock.

The separation of endothelium cells causes an additional reaction in the body; as it triggers a release of platelets into the area. These platelets combine with collagen to form a clot in the tissue around the bubble.  Platelets also release serotonin which counters the effect of histamine and constricts blood flow to the area.


When the bubble is sufficiently large, this process is intense and noticeable in the body; where the swelling and inflammation cause pain or limit local body function; or changes in blood chemistry cause rash or illness. If significantly intense, they become symptoms of decompression sickness.

However, if the bubbles are small in size, this immune response may be sufficiently insignificant; so as to remain symptomatically unnoticeable to the victim. But if the occurrence of micro-bubbles is, nonetheless, high in frequency, then there may be widespread low-intensity immune reactions throughout the body. A sub-clinical reaction, but a reaction that does have an impact on the individual.

That impact may present general fatigue, weariness, sleepiness, reduced vitality, decreased energy or just a sense of being under par physically or mentally. Those symptoms are commonly known as decompression stress or sub-clinical DCS.

See also:  ‘The Complement System and Diving‘ by Dr. Ernest Campbell

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Andy Davis Technical Sidemount Wreck Diving Subic Bay Philippines RAID Courses Training

About the Author

Andy Davis is a RAID, PADI TecRec, ANDI, BSAC and SSI-qualified independent technical diving instructor who specializes in teaching sidemount, trimix and advanced wreck diving courses.

Currently residing in Subic Bay, Philippines; he has amassed more than 10,000 open circuit and CCR dives over 27 years of diving across the globe.

He has published numerous diving magazine articles, designed courses for dive training agencies and tests/reviews dive gear for scuba equipment manufacturers. He is currently writing a series of advanced diving books and creating a range of tech diving clothing and accessories

Prior to becoming a professional technical diving educator in 2006, Andy was a commissioned officer in the Royal Air Force and has served in Iraq, Afghanistan, Belize and Cyprus.

Originally posted 2018-03-07 23:56:22.

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