Timing is critical for exchange transfusion as treatment of pertussis
WASHINGTON — Exchange transfusion should be considered for pertussis treatment based on the early appearance of pneumonia, the presence of pulmonary hypertension and the rapid increase in white blood count, according to data presented here.
While the efficacy data remain insufficient to indicate routine use of exchange transfusion (ET) for treatment of pertussis, Delma J. Nieves, MD, Children’s Hospital Orange County, Orange, Calif., and colleagues reported results of a study that suggest this treatment may be effective if implemented at the right time.
Based on previous studies, the decision to perform an ET should be based upon the initial white blood cell (WBC) count and how quickly it rises.
Delma J. Nieves
“This requires WBC counts to be performed every 12 to 24 hours and rapidly rising counts 30,000 cells/mm3 or greater should prompt immediate consideration of ET,” Nieves and colleagues concluded.
The study included infants, all of whom were intubated. Five patients survived and five patients died. In each group, three patients were girls and two patients were boys. Among the five fatal cases, the average age at illness onset was 6 weeks, compared with the average age of 7 weeks in survivors.
The mean WBC count among fatal cases was 77,000/mm3, compared with 85,000/mm3 among survivors.
Pulmonary hypertension, shock/hypotension and pneumonia were present in all five fatal cases of pertussis and four of the five had organ failure noted in their chart before initiation of ET. Three infants received extracorporeal membrane oxygenation. None of these patients had seizures.
In contrast, two of the five infants who survived had pulmonary hypertension and four of the five patients had pneumonia, while none had shock/hypotension or organ failure; none received ECMO and three had seizures.
“Our research findings indicated that if we are going to consider ETs as a treatment option in a severe case of pertussis, we need to think about doing it sooner than later. You cannot wait until the patient already has hypotension, shock or evidence of organ failure,” Nieves told Infectious Diseases in Children. “The main point is to immunization infants and their mothers and not get to this point.”
For more information:
Nieves DJ. #1533.461. Presented at: Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington.
Disclosure: Nieves reports no relevant financial disclosures.