Metabolic and Hormonal Consequences of Exchange Transfusion via the Umbilical Artery or Vein

Abstract

Twenty exchange transfusions for hyperbilirubinaemia were performed via the umbilical vein or artery in 17 term and pre-term infants. Blood preserved with acid citrate and dextrose was used and the effect of the route of transfusion on plasma glucose, free fatty acid, insulin and growth hormone (GH) concentrations was measured during the transfusion and for 3 h afterwards. Infants transfused via the umbilical vein secreted more insulin than those transfused via the artery although both groups had similar rises in plasma glucose. After transfusion, glucose disappearance was faster and minimum plasma glucose levels were lower in infants transfused via the vein. This group had a smaller fall in plasma free fatty acids during transfusion, but otherwise plasma free fatty acid levels were similar in both groups. More GH was secreted by infants transfused via the artery resulting in higher plasma levels during and after transfusion.

Metabolic and hormonal changes during and after exchange transfusion with heparinized or ACD blood

“…Neither the present results nor those from transfusions performed via the umbilical artery (Cser and Milner, 1975) confirm this idea, but indicate rather that glucose homoeostasis in the second and third hours after transfusion is not closely related to the way in which the glucose load is handled in the first hour. Similar results in infants of diabetic mothers given a bolus injection of glucose were observed by Isles, Dickson, and Farquhar (1968 disappearance rates reported here are similar to those of erythroblastotic infants given an acute intravenous glucose injection (Falorni et al, 1972;M0lsted-Pedersen, Trautner, and J0rgensen, 1973).…”

“…The clinical impracticability of monitoring the catheter position weakens the use of transfusions performed via the umbilical vein as a research tool, but has no implication for the patient with regard to posttransfusion hypoglycaemia which was not related to plasma insulin levels. Lower and more homogeneous plasma insulin levels and less hypoglycaemia were recorded in transfusions performed via the umbilical artery (Cser and Milner, 1975).…”

Changes in Plasma Concentrations of Atrial Natriuretic Peptide during Exchange Transfusion in Premature Infants

“…Blood exchange may affect temporarily the activation or suppression of several hormone systems (4-6). Some of these are related to energy metabolism (7), while changes in vasoactive hormone activity may influence the blood pressure homeostasis.…”

Parathyroid hormone secretion during exchange transfusion.

“…All transfusions were performed via the umbilical artery or vein as described previously (Milner et al, 1972;Cser and Milner, 1975). 10 transfusions were performed with ACD blood, 9 with ACD blood to which 50,ug glucagon had been added, and 8 with blood anticoagulated with heparin.…”

“…In blood samples collected before, during, and after transfusion as described previously (Milner et al, 1972;Cser and Milner, 1975), estimations were made of the haematocrit, plasma concentration of albumin (Doumas, Watson, and Biggs, 1971), calcium by atomic absorption spectrophotometry, phosphate (Fiske and Subbarow, 1925), and citrate (Zender, 1969). Plasma PTH concentration was measured by an immunoradiometric assay (Addison et al, 1971) using a guinea pig antibody raised to bovine PTH which showed good crossreactivity with human PTH.…”