Pediatric Critical Care, Neonatal Medicine and Emergency, AP-HP Paris Saclay University, Bicêtre Hospital, Le Kremlin-Bicêtre, France.
Pediatric Intensive Care Unit, Department of Pediatrics, Gynecology and Obstetrics, Geneva University Hospital, Geneva, Switzerland.
Vox Sang. 2024 Nov;119(11):1191-1195. doi: 10.1111/vox.13722. Epub 2024 Aug 13.
Manual blood exchange (MBE) is a leukoreduction therapy for hyperleukocytosis in Bordetella spp.
We describe the impact of BE on clinical and biological parameters in critically ill children with malignant pertussis.
This is a monocentric retrospective review of patients with malignant pertussis infection treated with MBE. It describes the evolution of haemodynamic, ventilatory, haematologic and metabolic characteristics before and after MBE.
Between January 2006 and December 2021, nine patients (median age 43 days, range: 13-80 days) had 16 MBE for malignant pertussis. All patients were mechanically ventilated, and 7/9 patients developed pulmonary hypertension during their paediatric intensive care unit (PICU) stay. Overall, 3/9 patients survived, and the mean PICU length of stay was 8.5 days (range: 1-52 days). We found a significant reduction of the leukocyte count (pre-MBE: 61.8 G/L [interquartile range (IQR): 55.8-74.8] vs. post-MBE: 19.4 G/L [IQR: 17.7-24.1]; p ≤ 0.001) and significant oxygenation improvement (pre-MBE SpO/FiO: 190 [IQR: 106-200] vs. post-MBE SpO/FiO: 242 [IQR: 149-250]; p = 0.03). The main side effects were a significant reduction of thrombocytes (pre-MBE: 411 G/L [IQR: 166.5-563.5] vs. post-MBE: 66 G/L [IQR: 46-82.5]; p = <0.001) and of ionized calcium (iCa) (pre-MBE iCa: 1.3 [IQR: 1.22-1.37] vs. post-MBE iCa: 1.25 [IQR: 1.85-2.24]; p = 0.03).
MBE efficiently reduces leukocytes and improves oxygenation in severe Bordetella pertussis infection in infants. Careful monitoring of calcium and thrombocytes seems mandatory.
手动换血（MBE）是一种用于博德特氏菌属高白细胞血症的白细胞减少治疗方法。
我们描述了 BE 对患有恶性百日咳的危重症儿童的临床和生物学参数的影响。
这是一项对接受 MBE 治疗的恶性百日咳感染患者进行的单中心回顾性研究。它描述了 MBE 前后血液动力学、通气、血液学和代谢特征的演变。
2006 年 1 月至 2021 年 12 月，9 名患者（中位年龄 43 天，范围：13-80 天）接受了 16 次 MBE 治疗恶性百日咳。所有患者均接受机械通气，9 名患者中有 7 名在儿科重症监护病房（PICU）期间发生肺动脉高压。总体而言，3/9 名患者存活，PICU 住院时间的平均值为 8.5 天（范围：1-52 天）。我们发现白细胞计数显著减少（MBE 前：61.8 G/L [四分位距（IQR）：55.8-74.8] vs. MBE 后：19.4 G/L [IQR：17.7-24.1]；p ≤ 0.001），氧合显著改善（MBE 前 SpO/FiO：190 [IQR：106-200] vs. MBE 后 SpO/FiO：242 [IQR：149-250]；p = 0.03）。主要副作用是血小板显著减少（MBE 前：411 G/L [IQR：166.5-563.5] vs. MBE 后：66 G/L [IQR：46-82.5]；p < 0.001）和离子钙（iCa）减少（MBE 前 iCa：1.3 [IQR：1.22-1.37] vs. MBE 后 iCa：1.25 [IQR：1.85-2.24]；p = 0.03）。
MBE 可有效降低严重博德特氏菌属百日咳感染婴儿的白细胞计数并改善氧合。钙和血小板的密切监测似乎是必要的。
