Exchange transfusion

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

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

  • Exact steps dependent on whether blood will be exchanged via an apheresis machine and specific model
  • Apheresis may require large-bore central venous catheter (e.g. HD line or pheresis catheter
  • If no apheresis machine available:
    • Place at least two peripheral IVs
    • 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

See Also

External Links

References

Authors:

Claire