Exchange Transfusion, Newborn

An exchange transfusion is a procedure that removes your child's blood in small amounts and replaces it with fresh donor blood or plasma.

This may be needed for a variety of conditions including:

  • Rh incompatibility. This can happen when a woman with Rh-negative blood has a baby with Rh-positive blood. It is possible for a small amount of the baby's blood to enter into the mother's circulation during the pregnancy or labor. The mother's body then produces antibodies to destroy these cells. These antibodies can destroy the baby's red blood cells. The destruction of the baby's blood cells can cause severe anemia and jaundice.

  • ABO incompatibility (Hemolytic Disease of the Newborn). Everyone with group O blood has natural anti-A and anti-B antibodies. If the mother's blood group is O and her baby's blood group is A or B, her antibodies may destroy the baby's red blood cells in a similar way as that described for Rh incompatibility.

  • Severe jaundice that is not responding to treatment with phototherapy and intravenous immune globulin.

  • Severe infection.

  • Problems with blood chemistry.

  • Too little blood in the system (anemia).

  • Too much blood in the system (polycythemia) anemia can also occur in premature infants.

  • Toxic effects of drugs.

  • Sickle Cell Crisis.

RISKS AND COMPLICATIONS

Exchange transfusion is a procedure that has been carried out many times in the hospital. Like all procedures, there are small potential risks. These include:

  • Infection.

  • Low blood sugar.

  • Problems with blood clotting.

  • Unstable blood pressure.

  • Breathing problems.

  • Unstable electrolyte levels in the bloodstream.

  • Bleeding.

Your child will be monitored for these problems. He or she will be treated promptly in the unlikely event that any arise. The decision to perform an exchange transfusion will only have been made because the risks are greater for your child if it is not done.

BEFORE THE PROCEDURE

  • All feedings will need to stop. There may be a need to empty the stomach using a tiny, soft, flexible tube that is passed through the nose or mouth and down into the stomach (nasogastric tube).

  • Adult donor blood (screened to make sure there is no infection present) is checked to child's blood to ensure that it is compatible. If it for a newborn, it is also checked to make sure it is compatible with the mother's blood.

  • Your child will be connected to machines that will closely monitor:

  • Blood pressure.

  • Pulse.

  • Breathing rate.

PROCEDURE

This is a sterile procedure. Parents may be asked to leave the room. Your child may need to be under a warmer. Your child may be covered with sterile towels. This will create a safe and clean area where your caregivers will work. The steps of the procedure may take about an hour and include:

  • Small, soft, flexible tubes (catheters) need to be inserted into an artery and vein. In children, this is done in the hand or foot. In newborns, this is done usually through the belly-button.

  • A small amount of your child's blood is removed and replaced with warmed donor blood or plasma. This is done slowly over a few minutes.

  • This process is repeated every few minutes for up to two hours according to how much blood is exchanged. The amount of blood exchanged depends on the reason for the exchange transfusion.

  • Close monitoring continues throughout the entire exchange process.

AFTER THE PROCEDURE

Follow-up blood tests will be done over several hours. Catheters will be kept in place until his/her blood results indicate that a second exchange is not required. Feedings will be started 2-4 hours after the exchange is completed. Monitoring in the neonatal or pediatric intensive care unit is likely for a period of time after the procedure is completed. The clinical team will decide when this is no longer necessary.