RESUMO
La coqueluche grave es una variante clínica de la infección por Bordetella pertussis, que cursa con leucocitosis extrema, neumonía, insuficiencia respiratoria grave e hipertensión pulmonar, y acarrea una alta mortalidad. La hipertensión pulmonar es el evento crucial que desencadena el colapso cardiovascular, resistente al tratamiento y, en ella, participan la toxina pertussis y la leucostasia pulmonar. La remoción de la masa leucocitaria mediante exanguinotransfusión se plantea como una opción terapéutica. Presentamos el caso clínico de un paciente de 6 meses de edad con diagnóstico de coqueluche grave, que fue sometido a exanguinotransfusión de una volemia como medida de rescate cuando ya tenía hipoxemia resistente e hipertensión pulmonar. Se observó una reducción de la concentración de glóbulos blancos del 47% y una mejora en los parámetros de oxigenación que persistió durante 48 horas, momento a partir del cual el paciente evolucionó en forma tórpida con falla multiorgánica y murió.(AU)
Severe pertussis is a clinical variant of Bordetella pertussis infection that is accompanied by extreme leukocytosis, pneumonia, severe respiratory failure and pulmonary hypertension, and this condition carries a high mortality. Pulmonary hypertension is the crucial event that triggers refractory cardiovascular collapse, and pertussis toxin and pulmonary leukostasis are involved. Removal of leukocyte mass by exchange transfusion is proposed as a therapeutic option. We present a 6-month-old patient with diagnosis of severe pertussis, who underwent a single volume exchange blood transfusion as a rescue measure when the refractory hypoxemia and pulmonary hypertension were already present. We observed a reduction in the white blood cell count of 47%, and an improvement in oxygenation parameters that persisted for 48 hours, after which time the patient evolved into a torpid form with multiorgan failure and death.(AU)
Assuntos
Humanos , Transfusão de Sangue , Coqueluche , Hipertensão PulmonarRESUMO
A case of a 3-year-old boy with severe haemophilia A who had a successful neurosurgical drainage of a combined spontaneous left temporal subdural and intra-parenchimal haematoma is reported. Surgical intervention was required because of clinical worsening during conservative treatment with dexamethasone and factor VIII (FVIII) replacement therapy. Continuous FVIII infusion was given before, during and after the procedure. There were no surgical complications and neurological examination remains intact. Neurosurgical interventions may be reserved for special, high-risk cases, as the one presented.