An exchange transfusion requires that the person's blood be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles, each one most often lasts a few minutes.
What does exchange transfusion mean?
An exchange transfusion is a medical treatment in which apheresis is used to remove one person's red blood cells or platelets and replace them with transfused blood products. Exchange transfusion is used in the treatment of a number of diseases, including: ⁕Sickle cell disease ⁕Thrombotic thrombocytopenic purpura ⁕Hemolytic disease of the newborn
Can you eat before getting a blood transfusion?
Can you eat before getting a blood transfusion? There are generally no special restrictions on eating, though it does make sense to be well hydrated. There are also no restrictions on activities before or during the transfusion, as long as it doesn’t interfere with the IV if the line is already placed.
Can you ever donate blood after a blood transfusion?
In the United States is necessary for you to wait for 12 months after receiving a blood transfusion from another person. You may not donate blood if you received a blood transfusion after 1980 in the United Kingdom (England, Wales, Scotland, Northern Ireland, Channel Islands, Isle of Man, Gibraltar or Falkland Islands).
Does the transfusion replace lost blood?
A blood transfusion may be needed if you have a shortage of red blood cells. This may be because your body's not making enough red blood cells or because you have lost blood. A blood transfusion can replace blood you have lost, or just replace the liquid or cells found in blood (such as red blood cells, plasma or cells called platelets).
What is the difference between blood transfusion and exchange transfusion?
Most blood transfusions involve adding blood or blood products without removing any blood, these are also known as simple transfusions or top-up transfusions. Exchange transfusion is used in the treatment of a number of diseases, including sickle-cell disease and hemolytic disease of the newborn.
Where is exchange transfusion done?
An exchange transfusion is performed in a hospital or clinic. During the procedure, your blood will be removed and replaced with blood or plasma from a donor.
What is exchange transfusion in newborn?
Exchange transfusion (ET) is the removal of an infant's blood with high bilirubin levels and/or antibody-coated red blood cells (RBCs) and replacement with fresh donor blood.
What are the complications of exchange transfusion?
RisksBlood clots.Changes in blood chemistry (high or low potassium, low calcium, low glucose, change in acid-base balance in the blood)Heart and lung problems.Infection (very low risk due to careful screening of blood)Shock if not enough blood is replaced.
How long does an exchange transfusion take?
The exchange transfusion is done in cycles, each one most often lasts a few minutes. The person's blood is slowly withdrawn (most often about 5 to 20 mL at a time, depending on the person's size and the severity of illness). An equal amount of fresh, prewarmed blood or plasma flows into the person's body.
Who performs exchange transfusion?
Technique Two medical officers will perform an exchange transfusion using the arterial/venous 2 line technique (one of whom is experienced in the procedure). A registered nurse may assist an experienced medical officer if a second medical officer is unavailable.
Does exchange transfusion increase hemoglobin?
In the acute situation, simple transfusion will increase oxygen-carrying capacity but with a risk of hyperviscosity if the Hb is increased to significantly over the patient's baseline....Table 2.IndicationCommentAcute anemiaSimple transfusion to baseline HbAcute ischemic strokeExchange transfusion4 more rows
Why do babies go under blue lights?
Sometimes, special blue lights are used on infants whose levels are very high. These lights work by helping to break down bilirubin in the skin. This is called phototherapy. The infant is placed under these lights in a warm, enclosed bed to maintain a constant temperature.
Do blood transfusions replace all your blood?
A transfusion provides the part or parts of blood you need, with red blood cells being the most commonly transfused. You can also receive whole blood, which contains all the parts, but whole blood transfusions aren't common. Researchers are working on developing artificial blood.
How many blood transfusions can a person have in a week?
Is there a limit to how many blood transfusions a person can have? The answer to both questions is no. A blood transfusion is a common medical procedure. A transfusion may be needed to treat a long-term disease or a medical emergency.
What are the signs that you need a blood transfusion?
You might need a blood transfusion if you've had a problem, such as:A serious injury that's caused major blood loss.Surgery that's caused a lot of blood loss.Blood loss after childbirth.A liver problem that makes your body unable to create certain blood parts.A bleeding disorder, such as hemophilia.More items...
What are the special requirements for blood selected for an exchange transfusion?
At the beginning of the exchange transfusion, the first blood sample withdrawn should be sent for for 1)total and direct bilirubin; 2) hemoglobin and hematocrit; 3) glucose; and 4) calcium.
What is the nurse's role in an exchange transfusion?
The nurse is responsible for recording the volume balance throughout the exchange. Can occur from a variety of causes. Set the monitor to have an audible QRS complex. Blood for exchange transfusion is preserved in CPD (citrate, phosphate, dextrose) and can be quite acidotic.
How is partial exchange transfusion done?
Partial Exchange Transfusion has two methods; the first typically involves pre-transfusion phlebotomy of whole blood followed by a transfusion of PRBC (packed red blood cells). The second is removing whole blood using an IV in one arm while transfusing PRBC's into the other arm.
When does sickle cell anemia require exchange transfusion?
Exchange transfusion is a recommended part of the initial treatment of vaso-occlusive stroke in children. It is performed shortly after a non-contrast CT documents an infarctive rather than hemorrhagic stroke. Additional studies, such as MRI/MRA, should await the completion of the red cell exchange.
Why do people need exchange transfusions?
Exchange transfusion is a potentially life-saving procedure that is done to counteract the effects of serious jaundice or changes in the blood due to diseases such as sickle cell anemia.
What conditions can exchange transfusions be used for?
An exchange transfusion may be needed to treat the following conditions: Dangerously high red blood cell count in a newborn (neonatal polycythemia) Rh-induced hemolytic disease of the newborn. Severe disturbances in body chemistry. Severe newborn jaundice that does not respond to phototherapy with bili lights.
What happens after a blood transfusion?
An equal amount of fresh, prewarmed blood or plasma flows into the person's body. This cycle is repeated until the correct volume of blood has been replaced. After the exchange transfusion, catheters may be left in place in case the procedure needs to be repeated. In diseases such as sickle cell anemia, blood is removed ...
How long does an exchange transfusion last?
The exchange transfusion is done in cycles, each one most often lasts a few minutes.
How long do you have to stay in the hospital after a transfusion?
General risks are the same as with any transfusion. Other possible complications include: The patient may need to be monitored for several days in the hospital after the transfusion. The length of stay depends on what condition the exchange transfusion was performed to treat.
What is the term for a disease where blood is removed and replaced with donor blood?
In diseases such as sickle cell anemia, blood is removed and replaced with donor blood.
How long do you have to be monitored after a blood transfusion?
After the Procedure. Expand Section. The patient may need to be monitored for several days in the hospital after the transfusion. The length of stay depends on what condition the exchange transfusion was performed to treat.
What is an exchange transfusion?
An exchange transfusion is a blood transfusion in which the patient 's blood or components of it are exchanged with (replaced by) other blood or blood products. The patient's blood is removed and replaced by donated blood or blood components. This exchange transfusion can be performed manually or using a machine ( apheresis ).
How long does an exchange transfusion last?
The exchange transfusion is done in cycles: each one usually lasts a few minutes.
What is a top up transfusion?
Most blood transfusions involve adding blood or blood products without removing any blood, these are also known as simple transfusions or top-up transfusions.
How long do you have to stay in the hospital after a transfusion?
The person may need to be monitored for several days in the hospital after the transfusion, but the length of stay generally depends on the condition for which the exchange transfusion was performed.
How much blood is withdrawn at a time?
The patient’s blood is slowly withdrawn (usually about 5 to 20 mL at a time, depending on the patient’s size and the severity of illness), and a slightly larger amount of fresh, prewarmed blood or plasma flows into the patient's body. This cycle is repeated until the correct volume of blood has been replaced.
What is the target for hemoglobin S?
The target is usually to maintain a hemoglobin S level below 30% to prevent complications occurring.
Does exchange transfusion help with malaria?
Exchange transfusion has been used for the treatment of severe malaria in the past . However, in 2013 the CDC examined the limited evidence available and found no evidence that exchange transfusion has any beneficial effects (decreased mortality) in people with very high parasite loads (> 10%).
Why is exchange transfusion important?
Exchange transfusion occupies a unique place in the history of neonatal jaundice because it was the first intervention to permit effective control of severe hyperbilirubinemia and prevent kernicterus. In addition to the immediate control of hyperbilirubinemia, an exchange transfusion in immune-mediated hemolytic disease also achieves (1) the removal of antibody-coated red blood cells (a source of “potential” bilirubin), (2) the correction of anemia (if present), and (3) the removal of maternal antibody. A “double volume” exchange refers to an exchange of twice the neonate's blood volume, or approximately 170–200 mL/kg, and removes approximately 110% of circulating bilirubin (extravascular bilirubin enters the blood during the exchange) but only 25% of total body bilirubin. The exchange transfusion is much less efficient in the removal of total body bilirubin because the majority of the infant's bilirubin is in the extravascular compartment ( Valaes, 1963 ). Postexchange bilirubin levels are approximately 60% that of preexchange levels, but the rapid (~30 min) reequilibration of bilirubin between the vascular and extravascular compartments produces a rebound of serum bilirubin levels to 70%–80% preexchange levels ( Brown et al., 1957 ).
What is partial exchange transfusion?
A partial exchange transfusion is often performed in hydropic infants or those with severe anemia associated with cardiac failure or volume overload. The volume of blood required for the exchange transfusion may be calculated by the following formula:
How much does a double volume transfusion replace?
Although a double volume exchange transfusion replaces 85% to 90% of the blood volume, when the exchange transfusion is performed for severe hyper-bilirubinemia, the drop in serum bilirubin is often less than 50%, because of equilibration from a tissue-bound pool.
What is the effect of an exchange transfusion on hemolytic disease?
In addition to the immediate control of hyperbilirubinemia, an exchange transfusion in immune-mediated hemolytic disease also achieves (1) the removal of antibody-coated red blood cells (a source of “potential” bilirubin), (2) the correction of anemia (if present), and (3) the removal of maternal antibody.
What are the unintended consequences of exchange transfusion?
The unintended consequences of exchange transfusion include cardiovascular, hematologic, gastrointestinal, biochemical, and infectious hazards, among others (Watchko, 2000c). Previously reported overall mortality rates associated with exchange transfusion ranged from 0.3 to 0.95 per 100 procedures (Hovi et al, 1985; Keenan et al, 1985), and significant morbidity (apnea, bradycardia, cyanosis, vasospasm, thrombosis) was observed in 6.7% of infants who received exchange transfusion in the NICHD collaborative phototherapy study (Keenan et al, 1985). These rates, however, may not be generalizable to the current era if, as with most procedures, frequency of performance is an important determinant of risk and experience with exchange transfusion is decreasing (Newman e al, 1992). It is quite possible that the mortality (and morbidity) for this now infrequently performed procedure might be considerably higher than previously reported. On the other hand, none of the reports before 1986 included contemporary monitoring capabilities such as pulse oximetry. Jackson (1997) reported a 2% overall mortality rate (2 of 106) associated with exchange transfusions between 1980 and 1995 and a 12% risk of serious complications attributable to exchange transfusion in ill infants. Moreover, in infants classified as ill with medical problems in addition to hyperbilirubinemia, the incidence of exchange transfusion related complication leading to death was 8%. There were no procedure-related deaths in 81 healthy infants. Symptomatic hypocalcemia, bleeding related to thrombocytopenia, catheter-related complications, and apnea-bradycardia requiring resuscitation were common serious morbidities observed in this study, suggesting that exchange transfusion should be performed by experienced individuals in a neonatal intensive care unit with continuous monitoring (including pulse oximetry) prepared to respond to these adverse events (Jackson, 1997). Finally, although the risk of blood transfusion is now very low, transfusion always carries some infection risk (Schreiber et al, 1996). The risk estimates (risk per tested unit) for transfusion-transmitted viruses in the United States for the period 1991 through 1993 were as follows: for the human immunodeficiency virus (HIV), 1:493,000 (95% confidence interval, 202,000 to 2,778,000); for the human T cell lymphotropic virus (HTLV), 1:641,000 (256,000 to 2,000,000); for the hepatitis C virus (HCV), 1:103,000 (28,000 to 288,000); and for the hepatitis B virus (HBV), 1:63,000 (31,000 to 147,000) (Schreiber et al, 1996).
How much of an infant's blood is replaced by a single volume transfusion?
replaces approximately 85% to 90% of the infant’s blood volume. A single-volume exchange transfusion replaces approximately 60% of the infant’s blood volume. There is no advantage to performing an exchange transfusion exceeding two blood volumes, and similarly there is no major disadvantage in exchanging slightly less than two blood volumes (an issue that sometimes arises when arranging blood for exchange transfusions in large term neonates), since it may avoid the addition of another unit of blood and consequently an extra donor exposure.
How does exchange transfusion affect iron?
Exchange transfusions have been tried as a way of reducing iron loading and are associated with a reduction in blood requirements by about one-third.
What conditions can exchange transfusions be used for?
An exchange transfusion may be needed to treat the following conditions: Dangerously high red blood cell count in a newborn (neonatal polycythemia) Rh-induced hemolytic disease of the newborn. Severe disturbances in body chemistry. Severe newborn jaundice that does not respond to phototherapy with bili lights.
How long does an exchange transfusion last?
In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles, each one most often lasts a few minutes. The person's blood is slowly withdrawn (most often about 5 to 20 mL ...
What happens after a blood transfusion?
An equal amount of fresh, prewarmed blood or plasma flows into the person's body. This cycle is repeated until the correct volume of blood has been replaced. After the exchange transfusion, catheters may be left in place in case the procedure needs to be repeated. In diseases such as sickle cell anemia, blood is removed ...
What are the conditions that require a transfusion?
An exchange transfusion may be needed to treat the following conditions: 1 Dangerously high red blood cell count in a newborn (neonatal polycythemia) 2 Rh-induced hemolytic disease of the newborn 3 Severe disturbances in body chemistry 4 Severe newborn jaundice that does not respond to phototherapy with bili lights 5 Severe sickle cell crisis 6 Toxic effects of certain drugs
What is the term for a disease where blood is removed and replaced with donor blood?
In diseases such as sickle cell anemia, blood is removed and replaced with donor blood.
How long do you have to stay in the hospital after a transfusion?
The patient may need to be monitored for several days in the hospital after the transfusion. The length of stay depends on what condition the exchange transfusion was performed to treat.
What is an Exchange Transfusion?
Exchange transfusion is performed to remove the abnormal sickle red blood cells and replace them with normal red blood cells, reducing the incidence of complications, including acute chest syndrome, stroke, and multi-organ failure.
How does exchange transfusion affect blood?
An exchange transfusion lowers the percentage of hemoglobin S red blood cells in the body. When there are fewer sickled hemoglobin S cells in the bloodstream, there is less likelihood of buildup or blockage in blood vessels. Exchange transfusion also increases the concentration of normal red blood cells in the body, ...
How is a manual blood exchange done?
In a manual exchange, most often used for pediatric patients, the exchange is done in cycles. The person's blood is slowly withdrawn using small tubes, called catheters. The catheters, placed in to a vein in the arm of the individual, takes in about 5 to 20 mL of blood at a time, depending on the person's size.
What is an automated exchange?
In an automated exchange, either two large peripheral IVs or a dual-lumen central venous catheter is placed . This permits blood to be withdrawn and returned at the same time. The catheter is connected to sterile tubing in an apheresis machine, which separates the patient's blood into components (red blood cells, platelets, plasma). A portion of the patient's red blood cells are removed by the machine and are replaced with donor red blood cells.
What is exchange transfusion?
Exchange transfusion is the replacement of blood from newborn infants with elevated bilirubin level in their blood stream with donor blood containing normal bilirubin levels. Newborn infants that experience jaundice, the yellowing of the skin and eyes, have a buildup of bilirubin, a chemical that occurs during red blood cell breakdown, ...
Where was exchange transfusion developed?
Exchange transfusion is a therapy developed throughout the 1940s by Louis Diamond and a group of surgeons at the Children’s Medical Center in Boston, Massachusetts. During exchange transfusion, a physician inserts a plastic tube called a catheter through the umbilical vein of the infant to slowly remove infant blood ...
How to do a blood exchange?
Physicians insert a catheter into the umbilical vein , through the abdomen, and then allow blood to flow freely from the catheter before starting the exchange. Physicians send a sample of that original blood to a lab to be tested for original bilirubin levels and other nutrient levels , most often sugar, salt, hemoglobin, and calcium levels. The donor blood, which is O-negative and Rh-negative to prevent an attack from the infant’s immune system, is warmed to 37 degrees Celsius and can be inserted through the same umbilical catheter, called the push-pull technique, or through a peripheral vein in the abdomen. The amount of blood a physician removes from the infant at each interval must equal the amount of blood they infuse back into the infant. That is done to prevent complications within the cardiovascular system, such as cardiac arrest. During the push-pull technique, physicians remove up to 5 ml/kg of body weight of blood from the infant at a time and then replace it with donor blood. The minimum amount of time needed for an exchange is forty-five minutes. If done correctly, a standard double-volume exchange is extremely effective. Physicians remove around eighty-five percent of the infant’s circulating blood, which decreases their bilirubin level by half of the original amount due to the large amount of donor blood that is placed into circulation.
How effective is a double volume exchange?
If done correctly, a standard double-volume exchange is extremely effective. Physicians remove around eighty-five percent of the infant’s circulating blood, which decreases their bilirubin level by half of the original amount due to the large amount of donor blood that is placed into circulation.
How much does double volume exchange remove?
In the study, the physicians found that double-volume exchange removes more total bilirubin mass from the infant, 20 to 70 percent compared to single-volume exchange. Although both single-volume and double-volume exchange are considered effective, after ten days there is a total decrease in bilirubin and anemia in the infant, ...
What is EF in a pregnancy?
EF arises during fetal development when the immune system of the pregnant woman attacks the red blood cells of the fetus. In those cases, the pregnant woman’s immune system ...
What happens when a pregnant woman breaks down her red blood cells?
In those cases, the pregnant woman’s immune system recognizes proteins on the outside of the infant’s red blood cells, called Rh antigens, and attacks those cells. As a result, the fetus’s red blood cells break down, releasing high levels of bilirubin into the fetal bloodstream.
What is blood transfusion?
Overview. A blood transfusion is a routine medical procedure in which donated blood is provided to you through a narrow tube placed within a vein in your arm. This potentially life-saving procedure can help replace blood lost due to surgery or injury. A blood transfusion also can help if an illness prevents your body from making blood or some ...
Why do people need blood transfusions?
A blood transfusion also can help if an illness prevents your body from making blood or some of your blood's components correctly. Blood transfusions usually occur without complications. When complications do occur, they're typically mild.
Why does the immune system attack the transfused red blood cells?
Your immune system attacks the transfused red blood cells because the donor blood type is not a good match. The attacked cells release a substance into your blood that harms your kidneys. Delayed hemolytic reaction. Similar to an acute immune hemolytic reaction, this reaction occurs more slowly.
How long does it take for blood to decrease?
It can take one to four weeks to notice a decrease in red blood cell levels. Graft-versus-host disease. In this condition, transfused white blood cells attack your bone marrow. Usually fatal, it's more likely to affect people with severely weakened immune systems, such as those being treated for leukemia or lymphoma.
What is the difference between red and white blood cells?
Red cells carry oxygen and help remove waste products. White cells help your body fight infections. Plasma is the liquid part of your blood. Platelets help your blood clot properly. A transfusion provides the part or parts of blood you need, with red blood cells being the most commonly transfused.
Why do blood banks screen donors?
Blood banks screen donors and test donated blood to reduce the risk of transfusion-related infections, so infections, such as HIV or hepatitis B or C, are extremely rare.
How long does it take to get IV blood?
You'll be seated or lying down for the procedure, which usually takes one to four hours.
Why do babies need an exchange transfusion?
An exchange transfusion is a procedure to give your newborn baby donated blood. Your baby may need this procedure if he or she has jaundice or has a blood disorder such as Rh incompatibility or sickle cell anemia. Jaundice is caused by too much bilirubin in the blood. If your baby has jaundice, an exchange transfusion helps to remove bilirubin out ...
What is the purpose of blood tests for a newborn?
Blood tests: Healthcare providers will take a sample of your baby's blood to test it before, during, and after the exchange transfusion. Blood gases help healthcare providers know how much oxygen, acids, and carbon dioxide are in your baby's blood. Other blood tests show healthcare providers how your baby's blood, heart, and other organs are doing.
Overview
An exchange transfusion is a blood transfusion in which the patient's blood or components of it are exchanged with (replaced by) other blood or blood products. The patient's blood is removed and replaced by donated blood or blood components. This exchange transfusion can be performed manually or using a machine (apheresis).
Most blood transfusions involve adding blood or blood products without removing any blood, th…
Description
An exchange transfusion requires that the patient's blood can be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles: each one usually lasts a few minutes.
The patient’s blood is slowly withdrawn (usually about 5 to 20 mL at a time, depending on the patient’s size and the severity of illness), and a slightly larger amount of fresh, prewarmed blood …
Medical Uses
Transfusion therapy is used as an emergency procedure to treat life-threatening complications of sickle-cell disease as well as an elective procedure to stop these complications occurring.
• Acute cerebrovascular event (stroke)
• Acute chest syndrome with respiratory failure
• Multi-organ failure
Risks
General risks are the same as with any transfusion. Other possible complications include:
• Blood clots
• Changes in blood chemistry (high or low potassium, low calcium, low glucose, change in acid-base balance in the blood)
• Heart and lung problems
Recovery
The person may need to be monitored for several days in the hospital after the transfusion, but the length of stay generally depends on the condition for which the exchange transfusion was performed.
History
The technique was originally developed by Alexander S. Wiener, soon after he co-discovered the Rh factor.
See also
• Plasmapheresis
• Neonatal red cell transfusion
• Hemolytic disease of the newborn
• Exchange transfusion in sickle cell disease
External links
• Neonatal Partial Exchange Transfusion Calculator