Exchange transfusion

Hemolytic disease - exchange transfusion

Exchange transfusion is a potentially life-saving procedure that is done to counteract the effects of serious jaundice or changes in the blood due to diseases such as sickle cell anemia.

The procedure involves slowly removing the person's blood and replacing it with fresh donor blood or plasma.

Description

An exchange transfusion requires that the person's blood be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles, each one most often lasts a few minutes.

The person's blood is slowly withdrawn (most often about 5 to 20 mL at a time, depending on the person's size and the severity of illness). An equal amount of fresh, prewarmed blood or plasma flows into the person's body. This cycle is repeated until the correct volume of blood has been replaced.

After the exchange transfusion, catheters may be left in place in case the procedure needs to be repeated.

In diseases such as sickle cell anemia, blood is removed and replaced with donor blood.

In conditions such as neonatal polycythemia, a specific amount of the child's blood is removed and replaced with a normal saline solution, plasma (the clear liquid part of blood), or albumin (a normal blood protein). This decreases the total number of red blood cells in the body and makes it easier for blood to flow through the body.

Neonatal polycythemia

Polycythemia can occur when there are too many red blood cells (RBCs) in an infant's blood.

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Why the Procedure Is Performed

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
Phototherapy with bili lights
Bili lights are a type of light therapy (phototherapy) that is used to treat newborn jaundice. Jaundice is a yellow coloring of the skin and eyes. ...
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Severe sickle cell crisis
Toxic effects of certain drugs

Risks

General risks are the same as with any transfusion. Other possible complications include:

Blood clots
Changes in blood chemistry (high or low potassium, low calcium, low glucose, change in acid-base balance in the blood)
Heart and lung problems
Infection (very low risk due to careful screening of blood)
Shock if not enough blood is replaced

After the Procedure

The person may need to be monitored for several days in the hospital after the transfusion. The length of stay depends on what condition the exchange transfusion was performed to treat.

Open References

References

Golden WC, Watchko JF. Neonatal hyperbilirubinemia and kernicterus. In: Gleason CA, Sawyer T, eds. Avery's Diseases of the Newborn. 11th ed. Philadelphia, PA: Elsevier; 2024:chap 72.

Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM. Blood disorders. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 124.

Park J. Hematology. In: Anderson CC, Kapoor S, Mark TE, eds. Harriet Lane Handbook, The: The Johns Hopkins Hospital. 23rd ed. Philadelphia, PA: Elsevier; 2021:chap 14.

Rodrigue BB, Sloan SR. Pediatric transfusion medicine. In: Hoffman R, Benz EJ, Silberstein LE, et al, eds. Hematology: Basic Principles and Practice. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 119.

Exchange transfusion - series

Presentation

<strong>Exchange transfusion - series</strong><p>Using bili lights is a therapeutic procedure performed on newborn or premature infants to reduce elevated levels of bilirubin. If blood levels of bilirubin become too high, the bilirubin begins to dissolve in the body tissues, producing the characteristic yellow eyes and skin of jaundice. Bilirubin also has an affinity for brain tissue, where it can accumulate and cause permanent brain damage.</p>

<strong>Infant jaundice - Indication</strong><p>Less frequently, when neonatal jaundice is more severe, and fluorescent light therapy is unable to break down all circulating bilirubin, exchange transfusion is often used. High levels of bilirubin in the blood can lead to brain damage and other serious problems. In these cases, 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. 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. </p>

<strong>Exchange transfusion - Procedure</strong><p>The infant is laid on their back, usually under a radiant warmer. The umbilical vein is catheterized with a fluid-filled catheter. The catheter is connected to an exchange transfusion set, incorporating lines to and from a waste container and a pack of donor blood. 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 now goes ahead in cycles, each of a few minutes duration. Slowly the infant's blood is withdrawn, and the fresh, pre-warmed blood or plasma is injected. After the exchange transfusion, an umbilical catheter may be left in place in case the procedure needs to be repeated within a few hours.</p>

Exchange transfusion - series

Presentation

Review Date: 11/6/2023

Reviewed By: Neil K. Kaneshiro, MD, MHA, Clinical Professor of Pediatrics, University of Washington School of Medicine, Seattle, WA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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