Exchange Transfusion: Indication and Adverse Effect

Abstract

Objective: To determine the indication and complications of exchange transfusion (ET) performed for neonatal hyperbilirubinaemia. Methods: The medical records of infants < 28 days old who required exchange transfusion (ET) due to neonatal jaundice in Special Care Baby Unit (SCABU), BIRDEM hospital from January 2009 to April 2010 were retrospectively reviewed. Results: Exchange transfusion was performed in 30 neonates during the study period. Indications of exchange transfusion were ABO incompatibility (30.0%), Rh incompatibility (13.3%), septicaemia (6.6%) and in majority causes, were unidentified (50%). Most common complication were thrombocytopenia (33.3%) hyperkalaemia (20%), hypocalcaemia (16.7%) Conclusion: Indication of ET was unidentified in majority cases and among identified cases most common causes was ABO incompatibility. Adverse events were common after exchange transfusion.DOI: http://dx.doi.org/10.3329/bjch.v36i1.13029Bangladesh J Child Health 2012; Vol 36 (1): 16-19

Study on neonates who received exchange transfusion at Dhaka shishu hospital

“…3 Begum et al, weisz et al and Ekteish et al also found similar results in their study. 5,6,8 In this study 5(13%) were PTLBW, 10(26%) were PTLBW with Septicaemia, 2(5%) had Septicaemia, 3(8%) had Perinatal asphyxia, 4(10%) were Infant of diabetic mother (IDM), 3(8%) had Congenital heart disease and 2(5%) had acute bilirubin encephalopathy as comorbidities along with hyperbilirubinaemia. Twelve (31%) cases came with only hyperbilirubinaemia without co-morbidity.…”

“…Unlike this study where Rh incompatibility was more, Dikshit et el and Sanpavatet al reported that ABO haemolytic disease of newborns was the most common cause of ET in neonates (35.9% and 21.3%, respectively). 3,6 Multiple exchange transfusions were required in 2(5%) cases. This is similar to findings of Ekteish et al, Begum et al and Dikshit et al reports.…”

“…3 T h e bilirubin level at which exchange transfusion is indicated remains controversial. 6 This is because it is very difficult to define the risk of bilirubin encephalopathy in various categories of patients. 6 Current recommendations for performing ET are based on balance between the risks of encephalopathy and the adverse events related to the procedure 6 .…”

“…6 This is because it is very difficult to define the risk of bilirubin encephalopathy in various categories of patients. 6 Current recommendations for performing ET are based on balance between the risks of encephalopathy and the adverse events related to the procedure 6 . The aim of this study is to determine the indication and complications of exchange transfusion (ET) performed in neonatal hyperbilirubinaemia.…”

“…Although ET is considered a safe procedure, it is not risk free and mortality rates vary from 0.5 to 3.3%. [6][7][8][9] The complications depend on several co-morbid conditions. 3 T h e bilirubin level at which exchange transfusion is indicated remains controversial.…”