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Exchange transfusion in the management of critical pertussis in young infants: a case series
Pham Thai Son1, Abdullah Reda2, Do Chau Viet1
1Department of Infectious Diseases, Children's Hospital No.2, Ho Chi Minh, Vietnam.
Insights
Early exchange transfusion (ET) can be a life-saving treatment for severe pertussis (whooping cough) in children. This procedure rapidly reduces high white blood cell counts, preventing critical complications.
Area of Science:
- Pediatric Infectious Diseases
- Hematology
- Critical Care Medicine
Background:
- Severe leucocytosis in pertussis (whooping cough) is linked to pulmonary hypertension and restricted blood flow.
- Exchange transfusion (ET) is a recognized method for reducing high white blood cell counts.
Purpose of the Study:
- To evaluate the effectiveness of exchange transfusion (ET) in managing severe pertussis-induced respiratory distress.
- To analyze cases of pertussis complicated by severe leucocytosis.
Main Methods:
- Retrospective case series of four pediatric pertussis patients with severe leucocytosis and respiratory distress requiring mechanical ventilation.
- PCR confirmation of pertussis infection.
- Assessment of outcomes following exchange transfusion.
Main Results:
- Three patients underwent double volume ET for leucodepletion.
- Two patients treated with ET showed positive outcomes with discharge.
- One patient died despite late ET; another patient who did not receive ET also died.
Conclusions:
- Early exchange transfusion (ET) shows promise as a rapid, life-saving intervention for critical pertussis with severe leucocytosis.
- Timely ET may prevent the development of cardiopulmonary complications in pediatric pertussis patients.
Background And Objectives:
It is proposed that severe leucocytosis mainly contributes to pulmonary hypertension by blocking pulmonary capillaries and restricting blood flow. Exchange transfusion (ET) in pertussis has been demonstrated as a safe and useful technique for depleting the leucocyte mass. We aim to discuss four cases of pertussis-induced respiratory distress and the effectiveness of ET in such a setting.
Materials And Methods:
We conducted a retrospective case series at the Infectious Disease Department of Children's Hospital 2 in Ho Chi Minh City, Vietnam, and included four pertussis patients that were confirmed by PCR tests on respiratory secretions, presented with severe leucocytosis and respiratory distress and required mechanical ventilation.
Results:
Among the included patients, three underwent a double volume ET for leucodepletion, two of whom were discharged after the procedure with proper vitals and laboratory test results. On the other hand, one patient died despite ET, performed late in the course of the disease. Exchange transfusion was not performed in the last patient who died as well.
Conclusion:
Early ET may be a useful and rapid life-saving treatment in children with critical pertussis and severe leucocytosis before cardiopulmonary complications appear.
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