Polycythemia in a neonate may be associated with cyanosis, cardiomegaly and/or congestive heart failure. The goal of partial exchange transfusion is to reduce the red blood cell mass to a level not causing symptoms.


Polycythemia in a neonate is defined as the occurrence at any time in the first week of life of either:

(1) a venous hematocrit > 65%, OR

(2) a hemoglobin > 22 g/dL


The goal of partial exchange with plasma is to lower the hematocrit to 55-60%.


Procedure: Whole blood is removed. An equal volume of fresh frozen plasma or 5% human albumin is then infused into the patient.


volume to blood to remove and plasma to infuse =

= ((blood volume) * ((observed hemoglobin) - (desired hemoglobin)) / (observed hemoglobin))



• The blood volume of a full-term infant is about 85-87 mL / kg.

• For premature infants, the blood volume is 108 mL / kg.

• The desired hemoglobin may range from 18.7 to 20.4 g/dL (these correspond to 55 to 60 percent hematocrit, respectively).


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