Modified double-volume exchange transfusion in 2 infants with severe pertussis and hyperleukocytosis

INTRODUCTION: Pertussis is an acute respiratory infectious disease caused by Bordetella pertussis. Hyperleukocytosis in pertussis contributes to a drastically worsened prognosis by promoting pulmonary hypertension and multiorgan failure, leading to accelerated disease progression and elevated mortality. Exchange transfusion can improve the prognosis of in children with pertussis and increase the success rate of treatment. METHODS: We retrospectively analyzed 2 infants with severe pertussis treated with modified exchange transfusion. Reconstituted whole blood was prepared using O-type leukoreduced concentrated red blood cells and AB-type leukocyte-reduced, virus-inactivated fresh frozen plasma, with a red blood cell to plasma ratio of 1:1 to 2:1 and a hematocrit of 40% to 50%. The total exchange volume was 150 to 180 mL/kg (approximately twice the blood volume). RESULTS: After exchange transfusion, both infants showed marked reduction in white blood cell count and clinically significant improvement in dyspnea. No severe adverse reactions occurred, and both children were discharged. DISCUSSION: Modified double-volume exchange transfusion is a safe and effective treatment for infants with severe pertussis and hyperleukocytosis.