Exchange transfusion and plasma-exchange in acute autoimmune hemolytic anemia: report of one case.
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Adult↗
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Results for “EXCHANGE TRANSFUSION”
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Treatment of transfusion-transmitted babesiosis by exchange transfusion.
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Aged↗
Preoperative exchange transfusion in sickle cell anemia.
Preoperative transfusion therapy is largely responsible for the recently improved morbidity and mortality in patients with sickle cell anemia undergoing surgery. The transfusion techniques recommended are several. Fifty patients have undergone 67 operations over the past 15 yr. The complications encountered in patients receiving simple transfusion or partial exchange transfusion do not differ. There remains theoretic advantage in the use of preoperative partial exchange transfusion with quantitation of hemoglobin S.
Adolescent↗
Effect of phototherapy and exchange transfusion on primary bile acids in the serum of hyperbilirubinaemic newborns.
Serum primary bile acid (cholic (CA) and chenodeoxycholic (CDCA) acid) concentrations were measured in 14 preterm and 11 full-term hyperbilirubinaemic newborns at the beginning and end of, and 24 and 72 hours following phototherapy. Only in the preterm newborns with gestational ages of 35-38 weeks there was a significant decrease of mean serum bile acid concentrations which could be shown 72 hours after the beginning of phototherapy. It can be hypothesized that the decrease was a result of a direct effect of light on the excretory liver function. Serum CA and CDCA concentrations were also measured in 5 hyperbilirubinaemic newborns at the beginning and end, and 24, 48 and 72 hours after the end of exchange transfusion. Exchange transfusion caused a clear immediate decrease in the mean serum primary bile acid concentrations. However, on day 2 after exchange transfusion the mean serum concentration of CA was about 150% and that of CDCA about 110% of the initial values. The most hyperbilirubinaemic newborns had extremely high primary bile acid serum concentrations before therapy. As bile acids compete with bilirubin for albumin binding it should be considered whether high bile acids in the serum of hyperbilirubinaemic newborns presuppose exchange transfusions.
Bilirubin↗
Changes in auditory brainstem responses in hyperbilirubinemic infants before and after exchange transfusion.
Auditory brainstem responses (ABR) were evoked, before and after exchange transfusion, in an effort to determine whether hyperbilirubinemia is associated with acute effects on brainstem function of neonates. Nine full-term infants with hemolytic disease received exchange transfusion for conventional serum bilirubin concentration indications (mean 22.3 +/- 1.4 mg/dL). In three infants, wave-absence before exchange transfusion was followed by appearance of the waves after exchange transfusion. Other significant alterations observed in the group after exchange transfusion were increase of wave amplitudes and reduction of interpeak latencies (brainstem transmission time 5.80 +/- 0.36 ms after exchange transfusion compared with 6.25 +/- 0.30 ms before exchange transfusion, P less than 0.001). These improvements are considered to have been brought about by removal of bilirubin from the body and from the brainstem during exchange transfusion. Acute brainstem toxicity appears to occur in a percentage of infants with hyperbilirubinemia at serum levels commonly seen in clinical practice. These changes appear to be rapidly reversible with exchange transfusion.
Bilirubin↗
Neonatal hyperviscosity. II. Effect of partial plasma exchange transfusion.
To determine the effect of partial plasma exchange transfusion, 20 newborn infants with neonatal hyperviscosity were randomly assigned to observation or treatment with partial plasma exchange transfusion within the first eight hours after birth. They were studied for organ involvement by roentgenogram, blood count, coagulation studies, and neurologic behavior and were followed up using the Brazelton Neonatal Behavior Assessment scale at 8, 24, and 72 hours and 2 weeks of age; in addition, ten control infants without hyperviscosity of similar birth weights and gestational ages were also studied. Exchange transfusion improved blood viscosity but both hyperviscous groups showed a higher proportion of abnormal results than did the control subjects. Infants receiving exchange transfusions subsequently improved during the period from 8 hours to 2 to 3 weeks of age, until they were indistinguishable from the control subjects. Neurologic improvement in hyperviscous infants who had not received exchange transfusions were significantly slower during this period. At 8 months of age, abnormal neurologic and developmental findings were impressive in both groups; no significant differences in neurologic abnormalities were noted at that time. Developmental delays, tremors, spastic diplegia, and monoparesis were found in four of six untreated infants and five of ten infants who had received exchange transfusions. A fine tremor was present in one control child.
Blood Viscosity↗
Pharmacokinetic considerations in exchange transfusion in neonates.
Neonates undergoing blood exchange often receive concomitant therapy. Questions may be raised whether dosage regimen alterations are necessary to replace drug lost as a result of the exchange procedure. Our study reports the changes in plasma concentration of kanamycin during an exchange transfusion and a pharmacokinetic analysis of the effect of the exchange on drug elimination. The relationships of the volumes of distribution, elimination rate constant, and time after dosing on the fraction of the dose eliminated in the blood exchange are developed on the basis of a one-compartment body model. Computer simulations using the equations developed were used to estimate the fraction of a dose that might be removed as a result of an exchange transfusion. As the disposition rate constant or the apparent volume of distribution increase, i.e., the clearance of the drug increases, the fraction of the dose removed by the exchange process decreases. Thus, significant amounts of drug removal may occur in an exchange transfusion for drugs with low clearance when the exchange is initiated early in the drug dosing interval. In our study, only 3% of the kanamycin dose was removed as a result of the exchange process, and dosing adjustment would not be required. This was in part due to initiation of the exchange late in the dosing interval, although the maximum calculated percentage of the dose which could have been removed under the exchange conditions employed was only 10%.
Exchange Transfusion, Whole Blood↗
The treatment of thrombotic thrombocytopenic purpura with exchange transfusions, plasma infusions, and plasma exchange.
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Blood Transfusion↗
[Complications of exchange transfusion in term and preterm newborns].
Exchange transfusion has an important role in the treatment of hyperbilirubinemia of the newborn. It is used in attempts to prevent kernicterus when bilirubin levels are high. We describe our experience in 203 exchange transfusions performed on 143 infants (81 males and 62 females) with hyperbilirubinemia during 1983-1992. In only 30% of cases was there a specific etiological diagnosis of the jaundice based on a positive Coombs test, G6PD deficiency, or the presence of sepsis or maternal diabetes; the rest were idiopathic. 57% of the neonates were premature (26-36 weeks of gestation). Premature neonates underwent more transfusions than full-term infants (1.6 vs 1.2). There was no direct death from exchange transfusion; morbidity was 6.3% (including bradycardia, apnea, thrombocytopenia, hypoglycemia and hyponatremia). Most complications occurred in preterm infants and those severely ill. All complications were treated immediately and there were no sequelae.
Exchange Transfusion, Whole Blood↗
Transfusion-associated falciparum malaria successfully treated with red blood cell exchange transfusion.
Falciparum malaria is frequently associated with significant morbidity and mortality. The use of exchange transfusion as a therapeutic modality for severe cases of malaria has been described previously. We describe a case of a 49 year-old African American gentleman with a history of hemoglobin-SC disease who presented with a severe case of Plasmodium falciparum malaria 3 weeks after having received an infected blood transfusion. His peripheral smear showed the presence of numerous intraerythrocytic ring forms and "banana-shaped" gametocytes with a high-grade parasitemia, estimated at 18%. He was treated with antimalarial chemotherapy and also underwent a 12-unit red blood cell exchange transfusion, decreasing his parasite load to < 1%, as determined on repeat smear. It is prudent to be aware of the efficacy of this adjunctive treatment, especially with ever-increasing travel and a resultant increase in the prevalence of tropical diseases in the United States.
Black or African American↗
Rapid correction of anemia with partial exchange transfusion.
Six pediatric patients have recently undergone eight partial exchange transfusions for anemias complicated by other clinical conditions. The procedure was well tolerated, and those patients who were in congestive heart failure exhibited good clinical improvement. This technique is particularly useful in situations where the patient is unable to tolerate the increased blood volume produced by other methods of RBC-transfusion therapy. We present a formula for estimation of partial exchange transfusion volume and suggest indications for partial exchange transfusion.
Adolescent↗
Anti-C haemolytic disease requiring intrauterine and exchange transfusion.
A case is presented of anti-C haemolytic disease of the newborn in which the infant required three intrauterine transfusions and an exchange transfusion after birth. Anti-C is not a common cause of haemolytic disease of the newborn and this is the first recorded case requiring intrauterine transfusion.
Adult↗
Elimination of pyridoxylated polyhemoglobin after partial exchange transfusion in chimpanzees.
Partial exchange transfusion with 8.5% pyridoxylated polyhemoglobin solution [PolyHb-PPa] was performed in five male chimpanzees weighing 22-30 kg. Serial blood and urine samples were obtained for 3 days. Percutaneous liver biopsies were performed on the 3rd to 4th, and the 9th to 11th days after PolyHb-PPa administration. Mean exchange volume was 42.5 +/- 10.7 ml/kg BW (26.8-54.6 ml/kg), mean Hb dose 3.7 +/- 0.9 g PolyHb-PPa/kg BW (2.4-4.8 g/kg), mean exchange rate 56.7 +/- 7.1% (48.2-67.4%). All animals survived long-term. Analysis of the plasma Hb concentration-time data showed a first order decline at a plasma level of 3.7 +/- 0.9 g PolyHb-PPa/kg BW. Mean intravascular half-life was 14.6 +/- 3.2 h. Total renal elimination of PolyHb-PPa was about 7%. PolyHb-PPa was absorbed and stored by Kupffer cells and transformed into hemosiderin. Siderosis of Kupffer cells and renal tubules had largely subsided 10 days after PolyHb-PPa indicating subsequent in vivo degradation and metabolization of the polymerized Hb fractions.
Animals↗
Severe falciparum malaria: predicting the effect of exchange transfusion.
The rationale for exchange transfusion (ET) in severe Plasmodium falciparum malaria is to lower the parasite burden rapidly, to replenish unparasitized cells and to correct severe anaemia. In addition, parasite antigens or 'toxins' may be removed. Despite reports of successful ET in the treatment of malaria since 1974, it remains controversial and its role and technique have been poorly defined. We present a mathematical model of ET which relates volume of exchange to reduction in parasitaemia and change in haemoglobin concentration. This model fits published and unpublished clinical data well, and should facilitate standardization of ET in future.
Blood Volume↗
Imbalance of globin chain synthesis in newborn infants with hemolytic disease after exchange transfusion.
The relative rates of beta-, gamma-, and alpha-globin chain formation in reticulocytes of six newborn infants ,ith hemolytic disease were determined before and in weekly intervals after exchange transfusion. Directly after birth (before exchange transfusion) the beta/alpha, gamma/alpha, and (beta + gamma)/alpha ratios in newborn infants with hemolytic disease (0.35 +/- 0.20, 0.67 +/- 0.12, and 1.06 +/- 0.29) were similar to those of normal newborn infants (0.33 +/- 0.07, 0.65 +/- 0.06, and 0.98 +/- 0.06). The gradual increase in the beta/alpha ratio seen during the postnatal period of eight normal newborn infants was also observed in newborn infants with hemolytic disease after exchange transfusion. In contrast, the gamma/alpha ratio was found to be increased (1.89 +/- 0.25) in all infants with hemolytic disease in the second week after exchange transfusion. The corresponding value for normal newborn infants was 0.48 +/- 0.25. After exchange transfusion the number of hemoglobin F-containing erythrocytes increased. Possible reasohs for this imbalance of globin chain formation after exchange transfusion may be the decreased erythropoiesis and/or the abnormal high hemoglobin A concentration after exchange transfusion or the introduction of an unknown, gamma chain formation-stimulating agent by exchange transfusion. Speculation In newborn infants with hemolytic disease the repression of gamma-globin chain formation normally seen during the postnatal period is replaced by a stimulated gamma-globin chain production after exchange transfusion.
Erythroblastosis, Fetal↗
[Peristaltic hand pump (type PP-148) with a rotation counter for rapid blood transfusion with particular reference to exchange transfusions in newborn infants].
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Exchange Transfusion, Whole Blood↗
Two hundred intrauterine exchange transfusions in severe blood incompatibilities.
Two hundred intrauterine exchange transfusions were performed under local anesthesia in 107 cases of blood incompatibilities (60 fetuses with severe anemia and 47 with hydrops). Under sonographic guidance, depending on fetal and placental position, an optimal puncturing site was selected along the umbilical vein: placental insertion, fetal insertion, or fetal intraabdominal segment. Tests were immediately performed to confirm fetal origin of blood obtained and estimate hemoglobin level. Blood used for exchange transfusion was compatible with maternal blood and had a hematocrit value of 75%. Exchange transfusion was continued until a hemoglobin level of 16 gm/dl was reached. This procedure was first associated with intraperitoneal transfusions and was subsequently used independently once a month to maintain an adequate hemoglobin level. In 4 fetuses with hydrops, antenatal regression of this sign was observed in 33 cases (70.2%). Overall outcome of 107 fetuses after exchanges was 84 living neonates (78.5%), 15 deaths in utero, and eight neonatal deaths. The survival rate was 91.6% for fetuses without hydrops and 61.7% for those with hydrops. The advantage of exchange transfusion appears to be rapid and efficient correction of anemia with elimination of incompatible fetal red blood cells.
Birth Weight↗
Effect of exchange transfusion on serum reserve albumin for binding of bilirubin and index of serum bilirubin toxicity.
Seventeen newborn infants, who received their first exchange transfusion due to hyperbilirubinaemia and/or rhesus haemolytic disease, were studied. The exchange transfusions were performed with fresh, citrated blood. During the exchange transfusion a marked increase in the serum reserve albumin concentration for binding of bilirubin measured by the [14C]-MADDS method was observed, followed by a smaller decrease after the transfusion. Plasma pH increased both during and after the exchange transfusion. During the exchange transfusion a drastic fall in index of serum bilirubin toxicity was observed, followed by a smaller increase after the transfusion. Citrate was not found to interfere in the binding of bilirubin to albumin. The results are in agreement with the clinical finding that an exchange transfusion performed with fresh, citrated blood effectively reduced the risk of bilirubin encephalopathy. The ratio in serum of binding albumin, i.e. bilirubin plus reserve albumin, to total albumin failed to be increased by the exchange transfusion, and a decrease occurred after the transfusion. These findings indicate the presence in infant serum of non-binding albumin. Donor albumin with intact binding potential is partly transformed into the non-binding variety in the course of one hour after the transfusion. In the most severely rhesus sensitized infant a drastic decline of the serum albumin binding capacity was seen during the first day of life.
Bilirubin↗