Efficacy of Whole Blood Reconstituted (WBR) in Exchange Transfusion (ET) in Hemolytic Disease of New Born (HDN) —A Study of 110 Cases

Abstract

Aim: This study was aimed to review and establish the practice of exchange transfusion (ET) with whole blood reconstituted (WBR) in hemolytic disease of newborn (HDN). Objectives: To observe fall in indirect serum bilirubin, correction of anemia and comparison with related studies. Background: Hemolytic disease of the Newborn is characterized by presence of IgG antibodies in maternal circulation, which causes hemolysis in the fetus by crossing the placenta and sensitizing red cells for destruction by macrophages in the fetal spleen with consequent hyperbilirubinemia. Exchange transfusion with or without phototherapy is the method of choice for treating the newborn with on going hemolysis Methods/Materials: Sample size consisted of 110 neonates in whom 119 exchange transfusions were carried out with WBR. WBR was prepared by suspending O Rhesus-D (RhD) positive/negative cells (compatible with neonate's/ mother's serum) in AB plasma. Double volume exchange transfusion(s) were carried out through umbilical vein by push-pull technique. Results: Out of 110 cases, 61 (55.5%) were of RhD HDN whereas ABO and other group HDN cases were 30 (27.3%) and 19 (17.3%) respectively. An average post-ET fall in indirect serum bilirubin by 54.6% and correction of anemia by 3.7 gm/dl were reported in the study. Conclusion: An average post-ET fall in indirect serum bilirubin and correction of anemia was found to be more significant when compared to other studies. Hence we recommend exchange transfusion in HDN with WBR to obtain reasonable fall in indirect serum bilirubin and high average rate of correction of anemia.

Study of Exchange Transfusion by Reconstituted Blood in Hemolytic Disease of Fetus & New Born

“…The post-ET average fall in indirect bilirubin was by 54.12%, which was better than previous studies in which it was 50% and 51.83% respectively. 11,12 In the present study the mean total serum bilirubin level before ET was 29.59±6.88 mg/dl and immediately after ET was 11.51±3.72 mg/dl. P value was < 0.05, so the difference was statistically significant so the ET was effective treatment.…”

“…11,12 In 08 cases of ABO-HDFN where average post-ET indirect serum bilirubin fall was 56.59%, which is more than the previous studies done by Sharma DC et al (2007) in which it was 54.3% and Sharma DC et al (2013) 54.12%. 11,12 Third group was of other blood group HDFN categorized as non-RhD and non ABO HDFN. Total numbers of such cases were three in which pre-ET indirect bilirubin was 26 -39 mg/dl.…”

“…11,12 Study which constituted 110 cases, had 61 (55.5%) cases of RhD HDFN 13,14 In all cases mean fall in post ET indirect serum bilirubin was 53.47%, which was better than the other studies in which fall in post ET indirect serum bilirubin was, 52.01%, 51.9% and 52% respectively 12,15,16 while it was comparable to mean fall in post ET indirect serum bilirubin level (54.6%) of study done by Sharma DC et al (2013) 11 In 20 cases of RhD HDFN where average post-ET indirect serum bilirubin fall was 52.12%, which was comparable with 51.7% and 55.66% in study done by Sharma DC et al (2007) and Sharma DC et al (2013) respectively. 11,12 In 08 cases of ABO-HDFN where average post-ET indirect serum bilirubin fall was 56.59%, which is more than the previous studies done by Sharma DC et al (2007) in which it was 54.3% and Sharma DC et al (2013) 54.12%. 11,12 Third group was of other blood group HDFN categorized as non-RhD and non ABO HDFN.…”

“…In present study, out of these 31 cases, in 19 cases (61%) ET has been performed once while 12 cases (39%) required ET twice and the range of total serum bilirubin was 18.0 -44.2 mg/dl and 30 -39 mg/dl respectively. In study done by Sharma DC et al (2013) in which out of 110 cases, in 101 cases (91.81%) ET has been performed once, while 09 (8.18%) cases required ET twice. The range of total serum bilirubin in all cases was 16.2 -45 mg/dl.…”

“…Badiee Z h ad found that out of 68 cases, in 60 cases (88%) ET has been performed once while 08 cases (12%) required ET twice. 11,12,13 In the present study, the mean total serum bilirubin levels in patients who required more than one ET was higher than in patients with single ET and the difference was statistically significant (33.7±3.36 vs. 26.68±5.21, P = 0.0003), opposite results were seen in study done in northwest Iran by Hosseinpour SS et al (35.66±12.21 vs. 29.12±6.30, p=0.09) in which the difference was not statistically significant. 17 The study conducted in Iran concluded that ET with whole blood reconstituted (WBR) or fresh whole blood was safe and efficient method for reducing hyperbilirubinemia.…”