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.
Romano
Michael J
MJ
Section of Critical Care, Department of Pediatrics, West Virginia University, Morgantown, West Virginia, USA. mromano@hsc.wvu.edu
Weber
Mark D
MD
Weisse
Martin E
ME
Siu
Benjamin L
BL
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