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 (...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2004-08, Vol.114 (2), p.e264-e266
Main Authors: Romano, Michael J, Weber, Mark D, Weisse, Martin E, Siu, Benjamin L
Format: Article
Language:English
Subjects:
Exchange Transfusion, Whole Blood
Female
Humans
Hypertension, Pulmonary - diagnostic imaging
Hypertension, Pulmonary - etiology
Hypertension, Pulmonary - therapy
Hypoxia - etiology
Hypoxia - therapy
Infant
Leukocyte Count
Oxygen - blood
Pneumonia, Bacterial - etiology
Pneumonia, Bacterial - therapy
Respiration, Artificial
Respiratory Insufficiency - etiology
Respiratory Insufficiency - therapy
Ultrasonography
Whooping Cough - blood
Whooping Cough - complications
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Summary: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.
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.114.2.e264