Exchange Transfusion, Blood; Newborn

Name of the Procedure:

Common Names: Blood Exchange Transfusion Technical Term: Neonatal Exchange Transfusion

Summary

An exchange transfusion is a procedure where a newborn's blood is removed and replaced with fresh donor blood or plasma. This treatment helps to remove harmful substances from the baby's blood, such as bilirubin in cases of severe jaundice.

Purpose

• Medical Condition/Problem: Severe neonatal jaundice, certain blood disorders, Rh incompatibility, infections, and severe anemia.
• Goals/Expected Outcomes: To lower extremely high levels of bilirubin, correct severe anemia, remove toxins or antibodies, and stabilize the newborn's condition.

Indications

• Symptoms/Conditions: Severe jaundice, hemolytic disease of the newborn, severe anemia, sepsis, drug toxicity, or metabolic imbalances.
• Patient Criteria: Newborns with dangerously high bilirubin levels not responding to phototherapy, those with certain blood disorders, or other severe conditions as indicated by the neonatologist.

Preparation

• Pre-Procedure Instructions: The newborn will be monitored closely before the procedure; fasting is typically not required for newborns.
• Diagnostic Tests/Assessments: Blood tests to determine bilirubin levels, blood type matching, and complete blood count (CBC).

Procedure Description

1. Insert two catheters - one for removing blood and one for infusing donor blood.
2. Blood will be slowly removed and simultaneously replaced with an equal amount of donor blood or plasma.
3. The process is closely monitored to ensure proper blood volume and vitals stability.
   • Tools/Equipment: Catheters, blood bags, infusion pumps, and monitoring devices.
   • Anesthesia/Sedation: Typically, local anesthesia is used at the catheter sites; general anesthesia is rare.

Duration

The procedure generally takes 1 to 3 hours, depending on the volume of blood to be exchanged.

Setting

Performed in a neonatal intensive care unit (NICU) within a hospital.

Personnel

• Neonatologist or pediatrician
• Neonatal nurse specialist
• Lab technician
• Possibly an anesthesiologist for assistance

Risks and Complications

• Common Risks: Infection, electrolyte imbalance, blood pressure changes.
• Rare Risks: Blood clots, severe allergic reaction, bleeding at catheter sites.

Benefits

• Expected Benefits: Rapid reduction of bilirubin levels, correction of anemia, removal of harmful substances, and stabilization of the newborn.
• Timeframe: Benefits are often noticed within hours to days post-procedure.

Recovery

• Post-Procedure Care: The newborn will be closely monitored for signs of improvement or any complications.
• Recovery Time: Varies, but usually the baby stays in the NICU for further monitoring and care.
• Restrictions/Follow-Up: Routine follow-up tests to monitor blood levels and overall health.

Alternatives

• Other Treatment Options: Phototherapy, intravenous immunoglobulin (IVIG).
• Pros/Cons of Alternatives: Phototherapy is less invasive but may not be effective in severe cases; IVIG is less effective in reducing bilirubin levels compared to exchange transfusion.

Patient Experience

• During Procedure: The baby may be sedated for comfort; monitoring ensures they remain stable.
• After Procedure: Some discomfort at catheter sites but generally well-tolerated. Pain management will be provided as necessary.

Pain management and comfort measures are prioritized, and the medical team ensures minimal discomfort for the newborn throughout the procedure.