### Description

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.