Description:

The infant is laid on his or her back, usually under a radiant warmer. The umbilical vein is catheterized by a fluid-filled catheter. The catheter is connected to an exchange transfusion set, incorporating lines from a pack of donor blood and to a waste container. 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 proceeds in cycles, each of a few minutes duration. Slowly the infant’s blood is withdrawn (usually in increments of 5 to 20 ml depending on the infants size and the severity of illness) and an equal amount of fresh, prewarmed blood or plasma is injected into the umbilical vein.. This cycle is repeated until a predetermined volume of blood has been replaced. After the exchange transfusion, an umbilical catheter may be left in place in case the procedure needs to be repeated within a few hours.

In diseases such as Rh sensitization with hemolysis and anemia blood is removed and replaced with donor blood. In conditions such as newborn plethora (polycythemia - a condition where there are too many red blood cells making the blood thick and difficult to circulate) a calculated portion of the infants blood is removed and replaced with a normal saline solution, plasma or albumin. This decreases the total load of red blood cells making easier for the infants heart to circulate the blood.

Indications:

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

What To Expect After:

Without treatment , the conditions necessitating an exchange transfusion could cause severe retardation or death. The exchange transfusion itself does carry considerable risk.. Rh incompatibility used to be the leading condition necessitating exchange transfusion. With prevention of Rh disease, polycythemia of the newborn has become the leading reason for exchange transfusion. Although exchange transfusions carry high risk the majority are successful in improving the infant’s condition.

Convalescence:

The infant may need to be monitored for several days in the hospital after the transfusion, but the length of stay depends on the condition for which the exchange transfusion was performed.

Risks:

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

• heart and respiratory problems (most commonly slow heart rate (bradycardia) and apnea)
• shock due to inadequate replacement of blood
• infection (although blood is carefully screened hepatitis B, hepatitis C and HIV remain possibilities)
• blockage of the blood vessels supplying the kidneys or intestines
• delayed liver problems
• disturbances in body chemistry