Severe pertussis may be accompanied by a marked lymphocytosis. Cherry et al listed indications for exchange blood transfusion to reduce the lymphocyte count. The authors are from multiple institutions in California.
Patient selection: infant <= 120 days (4 months) with severe pertussis
Monitoring a patient with severe pertussis:
(1) Monitor the WBC count every 12 hours. Admit to the PICU if the absolute lymphocyte count is rapidly rising.
(2) Continuously monitor cardiopulmonary function.
(3) Monitor for pneumonia with chest X-rays.
(4) Monitor for pulmonary hypertension with echocardiography.
Parameters:
(1) clinical status
(2) white blood cell count
(3) absolute lymphocyte count
(4) percent increased of the lymphocyte count in 24 hours
An initial exchange transfusion is performed if any of the following occur.
|
Clinical
|
WBC Count per microliter
|
Absolute Lymphocyte Count per microliter
|
Percent Increase in Lymphocytes in 24 Hours
|
|
cardiogenic shock
|
>= 25,000
|
>= 12,000
|
NA
|
|
pulmonary hypertension
|
>= 25,000
|
>= 12,000
|
NA
|
|
renal or other organ failure
|
>= 25,000
|
>= 12,000
|
NA
|
|
NA
|
>= 48,000
|
>= 15,000
|
NA
|
|
NA
|
>= 30,000
|
>= 15,000
|
>= 50%
|
Indication for repeat exchange transfusion:
(1) A >= 50% in the absolute lymphocyte count over 24 hours.
|
Clinical
|
WBC Count per microliter
|
Absolute Lymphocyte Count per microliter
|
Percent Increase in Lymphocytes in 24 Hours
|
|
NA
|
>= 40,000
|
NA
|
>= 50%
|
