Exchange Transfusion
ET is a high-risk procedure and should be performed only when the benefit of the procedure offsets the risks - Swathi Chacham
image by: Reema Sharif
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Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: A prospective study
Blood exchange transfusion (BET) was introduced in the late 1940s to decrease mortality and morbidity associated with hemolytic disease of the newborn, but subsequently, it was used for the treatment of severe hyperbilirubinemia due to any cause. In due course, its use extended to the treatment of other conditions such as severe sepsis, drug intoxication, hydrops fetalis, hyperammonemia, and refractory hyperkalemia.
However, tremendous progress in prenatal (intrauterine transfusion and anti-D immunoglobulin) and postnatal care of Rh iso-immunized fetuses along with efficient phototherapy has substantially reduced the need for BET over the years. The frequency of BET in developed countries…
Resources
Exchange Transfusion Guidelines
Exchange transfusion of the neonate is a potentially life-saving intervention that involves removing aliquots of blood and replacing with donor blood in order to remove abnormal blood components and circulating toxins whilst maintaining adequate circulating blood volume. In the case of the neonate this is primarily performed to remove antibodies and excess bilirubin.
Phototherapy and Exchange Transfusion Guidelines for Preterm Infants < 35 Weeks Gestational Age
Exchange transfusion is recommended for infants whose TSB levels continue to rise to exchange levels despite receiving intensive phototherapy to the maximal surface area Exchange transfusion is recommended if infant shows signs of acute bilirubin encephalopathy
A Guide to Exchange Transfusions
Exchange transfusions were developed in 1946 by serologist Alexander Solomon Wiener to combat infant fatality. This development saved over 200,000 lives. Since then they have been used in treatments for a number of diseases including sickle-cell disease, Jaundice, thrombotic thrombocytopenic purpura, and hemolytic disease of the newborn.
Exchange Transfusion for Jaundiced Newborns in the United States
As a direct result of those two technological developments, phototherapy and Rh factor therapy, exchange transfusion treatment for jaundice neonates has declined steadily since 1986. While its popularity with physicians has decreased over the years in favor of non-invasive techniques, exchange transfusion remains a valuable technique that effectively and quickly removes bilirubin from the infant’s blood stream to prevent toxicity from occurring and causing the infant permanent brain damage.
Having an exchange blood transfusion
Information for parents or carers of a child with sickle cell disease (SCD) and thalassaemia.
Neonatal exchange transfusion (NET) – what is its current net value?
Neonatal exchange transfusion (NET) has a very special place in the history of newborns with severe hyperbilirubinemia (SHB) who are at risk for kernicterus, and other neurodevelopmental problems. NET’s primary indication was and has been the hemolytic disease of the newborn (HDN),which is less common now due to the universal screening for iso-sensitization and also because of appropriate use of antenatal anti-Rh D antibody prophylaxis. In this review, an attempt is made to describe the historical perspective, indications, complications, procedural variations, NET trend, and current status along with future perspective.
Revisiting the Criteria for Exchange Transfusion for Severe Neonatal Hyperbilirubinemia in Resource-Limited Settings
Exchange transfusion (ET) for severe neonatal hyperbilirubinemia (SNH) is frequently undertaken in low- and middle-income countries (LMIC), in sharp contrast to the prevailing practice in high-income countries. However, the criteria for initiating this procedure in settings with limited resources for treating infants with SNH have not been systematically explored.
Adverse events following blood exchange transfusion for neonatal hyperbilirubinemia: A prospective study
Exchange transfusion (ET) for hyperbilirubinemia is associated with many complications. The complications are underreported as most of the published studies are retrospective, used varying definitions of adverse events (AEs) and variable follow-up periods.
Exchange transfusion safety and outcomes in neonatal hyperbilirubinemia
Hyperbilirubinemia affects upto 85% of neonates born at term gestation (≥37 weeks gestational age [GA]) and 80% of premature newborns Infants ≤ 29 weeks of GA had greater odds of death following ET compared with term infants. These data will support clinicians in evaluating risks and prognosis for infants who require ET.
MedlinePlus
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.
WikEM
Technically, "exchange transfusion" can refer to any blood product, but typically Involves removing patient's RBCs and replacing with donor RBCs. When treating neonatal polycythemia, RBCs are replaced with normal saline, albumin, or plasma rather than donor RBCs.
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