Severe pertussis and hyperleukocytosis: is it time to change for exchange?

Abstract

ET should be considered in all infants suffering from critical pertussis and hyperleukocytosis, even in secondary care community hospitals.

Pertussis: Microbiology, Disease, Treatment, and Prevention

“…Pulmonary hypertension develops as an indirect effect of PT through induction of lymphocytosis (hyperleukocytosis), in which the total white blood cell (WBC) count can exceed 1 ϫ 10 5 cells/mm 3 . These extremely high WBC counts produce lymphocyte aggregations in the pulmonary vasculature that result in increased pulmonary vascular resistance (149)(150)(151). In infants with pertussis, the lymphoid system is also affected.…”

“…This may reflect a hyperviscosity syndrome from the elevated WBC count. Several case reports suggested improved outcomes using exchange transfusion to reduce the WBC count (151,306,(364)(365)(366)(367)(368)(369)(370).…”

Severe Pertussis Pneumonia in an Infant: Treated with Exchange Transfusion: Case Report

“…We performed double volume ET immediately after clinical deterioration was observed in this patient. 2 The need for mechanical ventilation requirement and leukocytosis persisted in our patient despite hydration and intensive care until the ET was performed. The echocardiography was normal upon admission and during the follow-up period.…”

“…Severe pertussis pneumonia characterized by respiratory and cardiac failure frequently necessitate intensive care. 2 Severe leukocytosis defined as white blood cell (WBC) count higher than 100.000/μL is an independent predictor of death. In addition lymphocytosis, caused by the pertussis toxin (PT), leads to obstruction and hyperviscosity in the pulmonary arterioles and can cause pulmonary hypertension, and/or respiratory and cardiac failure.…”

Actualización en terapias de leucorreducción como alternativas para el tratamiento de coqueluche grave

“…Luego de estas 4 grandes series 23,29,30,32 publicadas, aparecen en la literatura reportes de casos [33][34][35][36][37] (Tabla 2), con un total de 6 exanguinotransfusiones y una supervivencia en los pacientes expuestos a dicho tratamiento del 100%.…”