Exchange transfusion
Definition:
Exchange transfusion is a life-saving procedure designed to counteract the effects of serious jaundice, infection, or toxicity. The procedure involves the staged removal of the infant's blood and replacement with fresh donor blood or plasma.
Description:
The infant is laid on his or her back, usually under a radiant warmer. The umbilical vein is catheterized by a fluid-filled catheter. The catheter is connected to an exchange transfusion set, incorporating lines from a pack of donor blood and to a waste container. These are connected by means of a four-way stopcock, to which is also attached the syringe used to remove and replenish the infant's blood. The exchange transfusion proceeds in cycles, each of a few minutes duration. Slowly the infant's blood is withdrawn (usually in increments of 5 to 20 ml depending on the infants size and the severity of illness) and an equal amount of fresh, prewarmed blood or plasma is injected into the umbilical vein. This cycle is repeated until a predetermined volume of blood has been replaced. After the exchange transfusion, an umbilical catheter may be left in place in case the procedure needs to be repeated within a few hours.
In diseases such as Rh sensitization with hemolysis and anemia blood is removed and replaced with donor blood. In conditions such as newborn plethora (polycythemia - a condition where there are too many red blood cells making the blood thick and difficult to circulate) a calculated portion of the infants blood is removed and replaced with a normal saline solution, plasma or albumin. This decreases the total load of red blood cells making easier for the infants heart to circulate the blood.
Indications:
Guidelines for an exchange transfusion include:
Update Date: 02/09/00
Updated by: J. Gordon Lambert, MD, Associate Medical Director,
Utah Health Informatics and adam.com
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