Exchange transfusion: Difference between revisions
ClaireLewis (talk | contribs) |
ClaireLewis (talk | contribs) No edit summary |
||
| Line 19: | Line 19: | ||
==Contraindications== | ==Contraindications== | ||
*Hemodynamic instability, sepsis, or otherwise unable to tolerate fluid shifts | |||
*Severe hypocalcemia (citrate anticoagulant can worsen hypocalcemia) | |||
==Equipment Needed== | ==Equipment Needed== | ||
*Supplies for [[vascular access]] | *Supplies for [[vascular access]] | ||
| Line 54: | Line 56: | ||
*[[Transfusion]] | *[[Transfusion]] | ||
*[[Sickle cell disease]] | *[[Sickle cell disease]] | ||
*[[Plasmapheresis]] | |||
==External Links== | ==External Links== | ||
Revision as of 17:11, 3 April 2017
Overview
- 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
- In contrast to simple transfusion, avoids hyperviscosity and volume overload
- Erythrocytapheresis: involves separating out patients RBCs from other blood components extracorporeally in a centrifuge, then returning the rest of the patient's blood to them with the donor RBCs
Indications
- Severe complications of sickle cell disease
- Stroke
- Acute chest syndrome (reserved for severe cases)
- Priapism (conflicting evidence for benefit)
- Other complications requiring transfusion when Hb >10
- Toxicities
- Sulfhemoglobinemia, severe
- Methemoglobinemia in patients with G6PD or with methemoglobinemia due to nitrite treatment of cyanide
- Severe hemolysis due to formic acid toxicity
- Severe hemolysis due to malaria or babesiosis
- Neonatal hyperbilirubinemia, extremely severe or unresponsive to phototherapy
Contraindications
- Hemodynamic instability, sepsis, or otherwise unable to tolerate fluid shifts
- Severe hypocalcemia (citrate anticoagulant can worsen hypocalcemia)
Equipment Needed
- Supplies for vascular access
- Packed RBCs for transfusion
- Apheresis centrifuge (and any associated supplies) if planning erythrocytapheresis
Procedure
- Place at least two peripheral IVs
- Next steps dependent on whether blood will be exchanged via apheresis
- If no apheresis machine available:
- Slowly remove 5-20mL of patient's blood
- Replace phlebotomized blood with warmed RBCs (or saline/albumin/plasma) in equal or greater amounts
- Repeat prior steps until desired amount transfused
Complications
- Hypovolemia, shock (if more blood removed than transfused)
- Acute transfusion reactions
- Delayed transfusion reactions
- PE/DVT
- Hypokalemia, hyperkalemia, hypocalcemia, hypoglycemia