How do you do an exchange transfusion in a neonate?
Exchange transfusion involves the sequential withdrawal and injection of aliquots of blood, through arterial and venous lines, either peripheral or central. Note arterial lines (umbilical or peripheral) should only be used for withdrawal of infant blood, not for injection of donor blood.
How is exchange transfusion calculated?
If the “push-pull” (single catheter) technique is utilized, no more than 5 ml/kg body weight should be withdrawn at any one time. The exchange volume is generally twice the infant’s blood volume, (generally estimated to be 80 ml/kg). The total volume exchange should not exceed one adult unit of blood (450-500 ml).
What level of bilirubin requires exchange transfusion?
2: If the TSB is at a level at which exchange transfusion is recommended (Fig 4) or if the TSB level is 25 mg/dL (428 μmol/L) or higher at any time, it is a medical emergency and the infant should be admitted immediately and directly to a hospital pediatric service for intensive phototherapy.
What are indications for doing an exchange transfusion in newborns?
Guidelines for an exchange transfusion include:
- Hemolytic disease of the newborn (Rh disease)
- Life-threatening infection.
- Severe disturbances in body chemistry.
- Toxic effects of drugs.
- Polycythemia.
Which blood should be given to babies for exchange transfusion?
Group O blood is commonly used for exchange transfusion in hemolytic disease of the newborn regardless of the blood group of the baby. The anti-A and anti-B isoagglutinins of the Group O donor blood cause hemolysis of the infant’s remaining A or B cells.
What blood is used for exchange transfusion?
ABO incompatibility: Use group O, Rh specific RBCs. These RBCs contain low levels of antibodies and lack antigen that could trigger any circulating maternal antibodies in the newborn. Subsequent transfusions should be done with RBCs that are compatible with that of the mother and infant.
When should I start exchange transfusion?
Exchange transfusion is indicated for avoiding bilirubin neurotoxicity when other therapeutic modalities have failed or are not sufficient. In addition, the procedure may be indicated in infants with erythroblastosis who present with severe anemia, hydrops, or both, even in the absence of high serum bilirubin levels.
How long does an exchange transfusion take?
The exchange blood transfusion process can take from one to four hours on the machine. This will depend on your clinical history and how much blood will be used during the procedure.
What are the indications for exchange transfusion?
An exchange transfusion may be needed to treat the following conditions:
- Dangerously high red blood cell count in a newborn (neonatal polycythemia)
- Rh-induced hemolytic disease of the newborn.
- Severe disturbances in body chemistry.
- Severe newborn jaundice that does not respond to phototherapy with bili lights.
What are indications for exchange transfusion?
Why the Procedure is Performed Dangerously high red blood cell count in a newborn (neonatal polycythemia) Rh-induced hemolytic disease of the newborn. Severe disturbances in body chemistry. Severe newborn jaundice that does not respond to phototherapy with bili lights.
When do you transfuse a neonate?
The indications for neonatal RBC transfusions differ based upon the rate of fall in hemoglobin (acute versus chronic anemia). The need for transfusion in an infant with acute blood loss is generally dependent upon persistent clinical signs of inadequate oxygen delivery following intravascular volume restoration.
How does an exchange transfusion work in a neonatal patient?
Exchange Transfusion: Neonatal Introduction An exchange transfusion involves removing aliquots of patient blood and replacing with donor blood in order to remove abnormal blood components and circulating toxins whilst maintaining adequate circulating blood volume.
What are the guidelines for infant blood transfusions?
Transfuse using irradiated (only infants with birth weights <1.5 kg) filtered to reduce CMV risk, packed red blood cells (Hct ≈ 85%). The blood bank routinely screens all blood for other viral pathogens including HIV, hepatitis B, hepatitis C, and HTLV I/II. Assuming a packed cell hematocrit of 80-90% and a blood volume of 80 mL/kg:
How long does it take for an exchange transfusion?
The exchange volume is twice the infant’s blood volume, using 85 ml/kg as the infant’s blood volume. This procedure should be done slowly, over a minimum of 45 minutes and the blood volume should be kept fairly constant.
When to warm up red blood cells for neonatal transfusion?
The Blood Services produce a special red cell component for neonatal exchange transfusion (Table 10.3). It is ordered in specially by hospitals when required and close collaboration between the clinical team, hospital transfusion laboratory and blood service is essential. The component should be warmed to 37°C immediately before transfusion.
