Exchange Transfusion

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