Neonatology Book

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Exchange Transfusion

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  1. Indications
    1. Severe Hyperbilirubinemia refractory to Phototherapy
    2. Hemolytic Disease of the Newborn
  2. Mechanism
    1. Extracts Antibody coated erythrocytes
    2. Extracts partially hemolyzed Red Blood Cells
    3. Replaces removed blood with uncoated donor RBCs
  3. Technique
    1. Usually performed at neonatal tertiary centers
    2. Umbilical Venous Catheter placed at 7 cm or less
    3. Alternate aspiration and infusion
      1. Aspirate 20 cc of infant's blood
      2. Infuse 20 cc of donors blood
      3. Consider only 5-10 cc volumes in tenuous patients
    4. Exchange twice the infant's blood volume (2 x 85 ml/kg)
  4. Complications (5-10% of infants)
    1. Mortality: 0.3%
    2. Air embolism
    3. Transient Vasospasm
    4. Transient Bradycardia
    5. Thrombocytopenia
    6. Transfusion reaction
    7. Disseminated Intravascular Coagulation
    8. Electrolyte disturbance
      1. Hypoglycemia
      2. Hyperkalemia
      3. Hypernatremia
      4. Hypocalcemia
      5. Metabolic Acidosis
    9. Sepsis
    10. Blood borne pathogen
      1. Cytomegalovirus
      2. HIV Infection
      3. Hepatitis
  5. Precautions
    1. Obtain lab work prior to exchange transfusion
    2. Lab findings on post-exchange blood are not helpful
    3. Pre-exchange blood sample labs
      1. Complete Blood Count
      2. Peripheral Smear
      3. Reticulocyte Count
      4. Bilirubin
      5. Calcium
      6. Glucose
      7. Total protein
      8. Infant blood type
      9. Coombs Test
  6. References
    1. Behrman (2000) Nelson Pediatrics, Saunders, p. 524
    2. (2000) Harriet Lane Handbook, Mosby, p. 431

Exchange Transfusion, Whole Blood (C0015236)

Definition (MSH)Repetitive withdrawal of small amounts of blood and replacement with donor blood until a large proportion of the blood volume has been exchanged. Used in treatment of fetal erythroblastosis, hepatic coma, sickle cell anemia, disseminated intravascular coagulation, septicemia, burns, thrombotic thrombopenic purpura, and fulminant malaria.
ConceptsTherapeutic or Preventive Procedure (T061)
ICD999.01, 99.01
MSHD005078
Englishblood exchange transfusion, EBT - Exchange blood transfusion, Exchange blood transfusion, Exchange transfusion, Exsanguination transfusion
Spanishexanguinotransfusion
Parent ConceptsTransfusion of blood and blood components (C0371802), Blood Transfusion (C0005841), Exchange Transfusion, Whole Blood (C0015236), Transfusion Of Blood Products (C0455012)
SourcesCSP, ICD9CM, MSH, MTHICD9, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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