人工换血对婴儿恶性百日咳杆菌感染的生物学影响。

IF 1.8 4区医学 Q3 HEMATOLOGY

Vox Sanguinis Pub Date : 2024-11-01 Epub Date: 2024-08-13 DOI:10.1111/vox.13722

Vladimir L Cousin, Caroline Caula, Pierre Tissières

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引用次数: 0

摘要

背景和目的：人工换血（MBE）是一种白细胞减少疗法，用于治疗博德特氏菌属感染中的高白细胞症：我们描述了 BE 对恶性百日咳重症患儿临床和生物学参数的影响：这是对接受MBE治疗的恶性百日咳感染患者进行的单中心回顾性研究。结果：2006 年 1 月至 2021 年 12 月期间，9 名患者（中位年龄 43 天，范围：13-80 天）因恶性百日咳接受了 16 次 MBE 治疗。所有患者均接受了机械通气，其中 7/9 的患者在入住儿科重症监护室 (PICU) 期间出现了肺动脉高压。总的来说，3/9 的患者存活了下来，在重症监护室的平均住院时间为 8.5 天（范围：1-52 天）。我们发现白细胞计数明显降低（MBE 前：61.8 G/L [四分位数间距 (IQR)：55.8-74.8] vs. MBE 后：19.4 G/L [四分位数间距 (IQR)：17.7-24.1]；p ≤ 0.001），氧合状况明显改善（MBE 前 SpO2/FiO2：190[IQR：106-200] vs. MBE 后 SpO2/FiO2: 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 = 结论：MBE 能有效减少白细胞并改善严重百日咳博德特氏菌感染婴儿的氧合。似乎有必要对钙和血小板进行仔细监测。

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Biological impact of manual blood exchange in malignant Bordetella pertussis infection in infants.

Background and objectives: Manual blood exchange (MBE) is a leukoreduction therapy for hyperleukocytosis in Bordetella spp.

Infection: We describe the impact of BE on clinical and biological parameters in critically ill children with malignant pertussis.

Materials and methods: 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.

Results: 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 SpO₂/FiO₂: 190 [IQR: 106-200] vs. post-MBE SpO₂/FiO₂: 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).

Conclusion: MBE efficiently reduces leukocytes and improves oxygenation in severe Bordetella pertussis infection in infants. Careful monitoring of calcium and thrombocytes seems mandatory.

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来源期刊

Vox Sanguinis 医学-血液学

CiteScore

4.40

自引率

11.10%

发文量

156

审稿时长

6-12 weeks

期刊介绍： Vox Sanguinis reports on important, novel developments in transfusion medicine. Original papers, reviews and international fora are published on all aspects of blood transfusion and tissue transplantation, comprising five main sections: 1) Transfusion - Transmitted Disease and its Prevention: Identification and epidemiology of infectious agents transmissible by blood; Bacterial contamination of blood components; Donor recruitment and selection methods; Pathogen inactivation. 2) Blood Component Collection and Production: Blood collection methods and devices (including apheresis); Plasma fractionation techniques and plasma derivatives; Preparation of labile blood components; Inventory management; Hematopoietic progenitor cell collection and storage; Collection and storage of tissues; Quality management and good manufacturing practice; Automation and information technology. 3) Transfusion Medicine and New Therapies: Transfusion thresholds and audits; Haemovigilance; Clinical trials regarding appropriate haemotherapy; Non-infectious adverse affects of transfusion; Therapeutic apheresis; Support of transplant patients; Gene therapy and immunotherapy. 4) Immunohaematology and Immunogenetics: Autoimmunity in haematology; Alloimmunity of blood; Pre-transfusion testing; Immunodiagnostics; Immunobiology; Complement in immunohaematology; Blood typing reagents; Genetic markers of blood cells and serum proteins: polymorphisms and function; Genetic markers and disease; Parentage testing and forensic immunohaematology. 5) Cellular Therapy: Cell-based therapies; Stem cell sources; Stem cell processing and storage; Stem cell products; Stem cell plasticity; Regenerative medicine with cells; Cellular immunotherapy; Molecular therapy; Gene therapy.