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Timing critical in managing severe pertussis with exchange transfusions
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Exchange blood transfusions to manage conditions like severe pertussis need to be done quickly before organ failure or shock set in, to be most successfully, according to recently published data.
Delma J. Nieves, MD, of Children’s Hospital of Orange County in California, and colleagues looked at chart data on ten infants who underwent exchange transfusion for treatment of severe pertussis with extreme leukocytosis while admitted to one of four pediatric intensive care units from 2005 through 2011.
Delma J. Nieves
Nieves and colleagues noted a link between earlier onset of illness and mortality, with infants who had illness onset at 6 weeks having a higher mortality rate than those who presented at 7 weeks. White blood cell counts were higher in the five infant survivors, 77,000/mm3 vs 85,000/mm3. However, the five infants who died all had pulmonary hypertension, shock/hypotension and pneumonia; three required extracorporeal membrane oxygenation (ECMO) and all but one had organ failure. In contrast, none of the five survivors had shock/hypotension, organ failure, nor ECMO.
The researchers concluded that exchange transfusion decisions “should be based on the early appearance of pneumonia, the presence of pulmonary hypertension and the rapidity in the rise of the WBC count,” and they said, that exchange transfusion timing should be early to be successful.
“I think the most important message is to consider exchange transfusion early in hospitalized cases of pertussis with very rapidly rising WBC before they are in failure. In our own hospital, the first patient we performed exchange transfusion was very sick already and did not survive,” Nieves told Infectious Diseases in Children. “For two subsequent severe cases that followed, we did ET early and these patients survived.”
Disclosure: The researchers reported no relevant financial disclosures.
Delma J. Nieves, MD, can be reached at Children’s Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA 92868; Email: dnieves@choc.org.
James D. Cherry, MD, MSc, can be reached at the David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, MDCC 22-442, Los Angeles, CA 90095-1752; email: jcherry@mednet.ucla.edu.
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