Exchange transfusions

• To prevent kernicterus caused by rapidly rising bilirubin.

• Most commonly needed in haemolytic disease of the newborn.

• For small volume transfusions, age of red cells does not matter. For exchange transfusions within 5d of collection. ([K+] levels rise in older blood).

• Transfusion should not take >5h/unit due to risk of bacterial proliferation.

• Volumes of 5mL/kg/h usually safe. Special hazards

• GvHD: in congenitally immunodeficient neonates immunocompetent donor T lymphocytes can cause GvHD—rare.

• Need to irradiate all blood products in these children. Also irradiate if first degree relatives used as donors.

• CMV infection: particular risk in low birth weight babies, or immunocompromised children undergoing transplantation. CMV seronegative donations should be used. Alternatively use (modern) leucodepletion filter to reduce risk.

• Hypocalcaemia—rare now, due to change of additive.

• Citrate toxicity, also rare nowadays due to improvements in additive.

• Rebound hypoglycaemia, induced by high glucose levels of blood transfusion anticoagulants.

• Thrombocytopenia—dilution, DIC.

• Volume overload.

• Haemolytic transfusion reactions in necrotising enterocolitis. Thought to be due to the 'T' antigen on baby's RBCs becoming exposed due to 425 action of bacterial toxin entering the blood from diseased gut. Anti 'T' is present in almost all donor plasma.

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