A feasibility and safety assessment of double volume blood exchange (DVBE) for pertussis-related hyperleukocytosis (PRHL) in paediatric patients in Kuwait—a retrospective pilot study

Abstract Background Pertussis continues to pose a significant global health challenge, particularly for infants, and despite high vaccination rates in Kuwait, severe complications such as pertussis-related hyperleukocytosis (PRHL) persist. The aim of this study was to evaluate the feasibility and safety of double volume blood exchange (DVBE) in managing PRHL among paediatric patients in Kuwait, an approach with limited existing evidence. Method Conducted over 12 months in the Paediatric Intensive Care Units (PICUs) of Farwaniya Hospital, the study included five critically ill patients aged 1 to 9 months with a confirmed diagnosis of pertussis, hyperleukocytosis (white blood cell (WBC) > 30,000–50,000 cells/mm 3 ), and who received at least one DVBE during their PICU stay. We meticulously collected demographic, clinical, laboratory, procedural, and outcome data, analysed using descriptive statistics and the Wilcoxon signed-rank test. Results The range of WBC counts before DVBE were 41 to 98 × 10 9 /L, which decreased to 8.2 to 40 × 10 9 /L post-DVBE, with declines ranging from 20 to 63.5 × 10 9 /L. Additionally, the Wilcoxon signed-rank test (Z statistic, − 2.023, p -value: 0.031) provide strong statistical evidence of significant WBC reduction post-DVBE. Conclusion This pilot study indicates that DVBE may be a feasible intervention for managing PRHL, with no major complications observed. The findings warrant cautious interpretation given the constraints of the small sample size, necessitating further research with larger cohorts to validate these initial observations and to better understand the potential benefits, risks, and optimal implementation strategies associated with DVBE in this specific clinical context.