Wu Yuanyuan, Gan Chuan
Health Management Center, The Second Affiliated Hospital of Chongqing Medical University, Chongqing Medical University, Chongqing, China.
Department of Infectious Diseases Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, The First Batch of Key Disciplines On Public Health in Chongqing, Chongqing, China.
Ital J Pediatr. 2025 Mar 18;51(1):82. doi: 10.1186/s13052-025-01933-9.
Extreme leukocytosis in pertussis is a rare condition, and without effective interventions to reduce white blood cell counts, the mortality rate can approach 100%. The clinical characteristics of these patients and the application of exchange transfusion (ET) in their management are not yet clear.
This retrospective study examines the clinical characteristics and impact of ET in infant pertussis with extreme leukocytosis.
We have included six infant pertussis patients with extreme leukocytosis, all of whom were female and underwent ET. Two patients survived, while four died. The surviving patients were relatively older at disease onset compared to those who died, and all three unvaccinated patients died. All patients required admission to the pediatric intensive care unit, presenting with fever, whooping cough, cyanosis, severe pneumonia, and respiratory failure. Pulmonary consolidation, cardiovascular failure, and pulmonary hypertension (PH) were also common, especially among those who died. Hypoglycemia and seizures were rare. Acute-phase proteins, such as C-reactive protein and procalcitonin, were elevated to varying degrees. ET effectively reduced peripheral blood leukocytes; however, a significant increase in leukocytes was observed 1-2 days after the first ET in the deceased patients.
Extreme hyperleukocytosis is more commonly observed in young female children with pertussis. Younger age, unvaccinated status, and the presence of concurrent heart failure and PH may be associated with a poor prognosis. ET can effectively reduce peripheral blood leukocytes, but a rapid leukocyte rebound post-ET may be indicative of impending death.
百日咳中的极度白细胞增多症是一种罕见病症，若没有有效的干预措施来降低白细胞计数，死亡率可接近100%。这些患者的临床特征以及换血疗法（ET）在其治疗中的应用尚不清楚。
这项回顾性研究考察了ET在患有极度白细胞增多症的婴儿百日咳中的临床特征及影响。
我们纳入了6例患有极度白细胞增多症的婴儿百日咳患者，均为女性且都接受了ET。2例患者存活，4例死亡。存活患者在发病时的年龄比死亡患者相对大一些，且3例未接种疫苗的患者均死亡。所有患者均需入住儿科重症监护病房，表现为发热、百日咳、发绀、重症肺炎和呼吸衰竭。肺实变、心血管衰竭和肺动脉高压（PH）也很常见，尤其是在死亡患者中。低血糖和癫痫发作很少见。急性期蛋白，如C反应蛋白和降钙素原，有不同程度的升高。ET有效降低了外周血白细胞；然而，在死亡患者中，首次ET后1 - 2天观察到白细胞显著增加。
极度白细胞增多症在患百日咳的年幼女童中更常见。年龄较小、未接种疫苗状态以及并发心力衰竭和PH可能与预后不良有关。ET可有效降低外周血白细胞，但ET后白细胞快速反弹可能预示即将死亡。
