Pertussis pneumonia, hypoxemia, hyperleukocytosis, and pulmonary hypertension: improvement in oxygenation after a double volume exchange transfusion.
A 3-month-old infant of 33 weeks' gestation was hospitalized with pneumonia caused by Bordetella pertussis. Respiratory insufficiency worsened, and on hospital day 3, there was severe pulmonary dysfunction (arterial oxygen pressure/fraction of inspired oxygen ratio: 120), extreme leukocytosis (white blood cell count 104,000/mm3), and severe pulmonary hypertension as assessed by 2-dimensional echocardiogram. A double volume exchange transfusion was performed to reduce the leukocyte mass. Oxygenation began to improve during the exchange and continued to improve over the ensuing 31 hours (arterial oxygen pressure/fraction of inspired oxygen ratio: 280). The white blood cell count fell dramatically after the exchange, and the rate of rise was slower after exchange therapy compared with preexchange.
Section of Critical Care, Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA. mromano@hsc.wvu.edu
Michael J
MJ
Romano
Mark D
MD
Weber
Martin E
ME
Weisse
Benjamin L
BL
Siu
D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D000860:Hypoxia / Q000209:etiology / Q000628:therapy*; D007223:Infant; D007958:Leukocyte Count; D010100:Oxygen / Q000097:blood; D018410:Pneumonia, Bacterial / Q000209:etiology / Q000628:therapy*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D014463:Ultrasonography; D014917:Whooping Cough / Q000097:blood / Q000150:complications*
D010100:Oxygen