An exchange transfusion equal to twice the patient's blood volume is typically recommended for newborns with hyperbilirubinemia.
Criteria for Exchange Transfusion
Evaluation of Neonate for Exchange Transfusion
Finding |
Monitor Patient |
Consider Exchange |
Exchange |
maternal anti-D antibody titer |
< 1:64 |
>= 1:64 |
|
cord blood hemoglobin |
> 14 g/dL |
12-14 g/dL |
< 12 g/dL |
cord blood bilirubin |
< 4 mg/dL |
4-5 mg/dL |
> 5 mg/dL |
newborn capillary blood hemoglobin |
> 12 g/dL |
< 12 g/dL |
< 12 g/dL and decreasing in first 24 hours |
Bilirubin Values Indicating Need for Exchange Transfusion in Newborn
Birthweight in Grams |
Uncomplicated |
Complicated |
< 1250 |
13 mg/dL |
10 mg/dL |
1250-1499 |
15 |
13 |
1500-1999 |
17 |
15 |
2000-2500 |
18 |
17 |
> 2500 |
20 |
18 |
where
• conversion factor of bilirubin from mg/dL to mmol/L is multiplication by 17.1
Complicated Newborn Condition includes:
(1) 5 minute Apgar score < 3
(2) PaO2 < 40 torr for 1 hour
(3) pH < 7.15 for 1 hour
(4) rectal temperature <= 35 °C
(5) serum albumin <= 2.5 g/dL
(6) signs of CNS deterioration
(7) proven sepsis
(8) proven meningitis
(9) hemolytic anemia
(10) birth weight < 1000 grams
Volume to Exchange
The blood volume of a full-term infant is about 85 mL / kg.
The volume of whole blood required for a two-volume exchange =
= ((baby's weight in kilograms) * 85 * 2) mL
If packed red cells and FFP are used for the exchange and if the target hematocrit is 50%, then:
volume of blood to exchange = X = ((baby's weight in kilograms) * 85 * 2) mL
volume of red cells needed = Y = (X / 2)
volume of packed red cells needed = Z = (Y / 0.7)
volume of FFP needed = (X - Z)
Be sure to keep the donor blood mixed during the exchange to prevent red cells from settling out.
Specialty: Clinical Laboratory, Pedatrics