Exchange transfusion in newborns is a procedure in which blood is removed from the baby and replaced with fresh blood to treat severe jaundice or anemia.
Exchange transfusion is often done when a baby has anemia or another condition that requires them to receive a transfusion. In this blog post, we will discuss the reasons why an exchange transfusion may be necessary, as well as how it is performed.
What is exchange transfusion in newborns?
Exchange transfusion in newborns is a life-saving procedure in which blood is removed from the baby and replaced with fresh blood. This is done to treat certain conditions, such as severe jaundice or anemia.
A partial exchange transfusion may be done if only a portion of the baby’s blood needs to be replaced. This is done by removing some of the baby’s blood and replacing it with an equal amount of fresh blood.
A total exchange transfusion is done if all of the baby’s blood needs to be replaced. This is done by removing all of the baby’s blood and replacing it with fresh blood.
A “double volume” exchange refers to an exchange of twice the neonate’s blood volume or more. Although a double volume exchange transfusion replaces 85% to 90% of the infant’s blood volume.
Why is exchange transfusion done?
Exchange transfusion may be done if the baby has:
- Severe jaundice (total bilirubin level 20 mg/dl or more) that is not improving with other treatments in preterm infants
- Hemolytic disease
- Severe anemia
- Acute bilirubin encephalopathy
- A blood disorder such as sickle cell disease or thalassemia
- Rh incompatibility can cause problems if the mother has Rh-negative blood and the baby has Rh-positive blood. In those cases, the pregnant woman’s immune system recognizes proteins on the outside of the infant’s red blood cells, called Rh antigens, and attacks those cells. As a result, the fetus’s red blood cells break down, releasing high levels of bilirubin into the fetal bloodstream.
How is exchange transfusion done?
Exchange transfusion in newborn is usually done in the hospital. The baby is connected to an IV (intravenous) line, and blood is removed from the baby’s body. Fresh donor blood is then given through the IV line. The procedure takes about two hours.
What are the benefits of exchange transfusion?
The benefits of exchange transfusion include:
- Lowering the level of bilirubin in the blood
- Treating anemia
- Reducing the risk of brain damage from jaundice
- Treating certain blood disorders
What are the side effects of exchange transfusion?
The side effects of exchange transfusion include:
- Allergic reaction to the blood
- Infection
- Bleeding
- Low blood sugar (hypoglycemia)
Exchange transfusion is a safe and effective procedure. However, as with any medical procedure, there are some risks. Be sure to discuss the risks and benefits of exchange transfusion with your child’s doctor before the procedure is done.
Can exchange transfusion be done more than once?
Yes, exchange transfusion can be done more than once if necessary. Phototherapy is commonly used to convert unconjugated bilirubin into a water-soluble and excretable form and can reduce the need for exchange transfusions.
When is exchange transfusion not recommended?
Exchange transfusion is not recommended if the baby has:
- A low blood sugar level (less than 40 mg/dl)
- A low platelet count (less than 50,000/mm^)
- A heart condition that makes anesthesia risky
Complications
There was a 12% risk of serious complications attributable to exchange transfusion in ill infants. Some of the complications include:
- Cardiac failure: This can occur when the heart is unable to pump enough blood to meet the body’s needs due to increased venous pressure and overloading of the heart.
- Bilirubin-induced encephalopathy (bilirubin-induced neurologic dysfunction).
- Hypotension: This is a condition in which the blood pressure is too low.
- Air embolism: This is a condition in which air bubbles enter the blood vessels and block them.
- Hemorrhage: This is a condition in which bleeding occurs.
- Infection: This can occur if the IV line is not placed properly or if germs enter the blood through the IV line.
Conclusion
In conclusion, exchange transfusion in the newborn is a procedure that should be reserved for only the most serious cases. It is a potentially life-saving procedure that can be used to treat a variety of conditions, but it is also a very invasive one. If you are considering exchange transfusion for your newborn, be sure to discuss all of the risks and benefits with your doctor.
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