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Pertussis (Whooping Cough)
PEDIATRICS Vol. 114 No. 2 August 2004, pp. e264-e266

ELECTRONIC ARTICLE

Pertussis Pneumonia, Hypoxemia, Hyperleukocytosis, and Pulmonary Hypertension: Improvement in Oxygenation After a Double Volume Exchange Transfusion

Michael J. Romano, MD*, Mark D. Weber, RN, CPNP*, Martin E. Weisse, MD{ddagger} and Benjamin L. Siu, MD§

* Section of Critical Care
{ddagger} Section of Infectious Disease
§ Section of Cardiology, Department of Pediatrics, West Virginia University, Morgantown, West Virginia

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.

Key Words: Bordetella pertussis • pulmonary hypertension • hyperleukocytosis • extracorporeal life support • exchange transfusion

Abbreviations: PHT, pulmonary hypertension • ECLS, extracorporeal life support • WBC, white blood cell • FIO2, fraction of inspired oxygen • PaO2, arterial oxygen pressure • NO, nitric oxide

Received for publication Jan 7, 2005; Accepted Mar 4, 2004.




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