What is an Exchange Transfusion in Newborns
An exchange transfusion is a procedure that removes your baby’s blood in small amounts and replaces it with donor blood or the yellow-colored liquid part of blood (plasma).
What are some reasons why my baby might need an exchange transfusion?
Your baby may need an exchange transfusion if he or she has:
- Hemolytic
disease of the newborn. Hemolytic disease happens when a mother’s disease
fighting system (immune system) attacks her baby’s red blood cells.
Proteins (antibodies) in the mother’s blood destroy the baby’s red
blood cells. Two conditions can cause hemolytic disease:
- ABO incompatibility. People with an O blood type have antibodies that can attack blood cells in type A or B blood. If a mother’s blood type is O and her baby’s blood type is A or B, her antibodies may destroy the baby’s red blood cells and cause hemolytic disease.
- Rh incompatibility. An Rh factor is a protein on the surface of red blood cells. Rh incompatibility happens when a mother has Rh-negative blood and her baby has Rh-positive blood. During pregnancy or delivery, blood from the baby can cross into the mother’s bloodstream. If a mother is Rh-negative and the baby is Rh-positive, the mother’s antibodies can destroy the baby’s red blood cells.
- Jaundice. This is yellowing of the skin and eyes. In a newborn, jaundice is usually caused by a buildup of waste products in the blood due to the breakdown of red blood cells that the baby cannot get rid of fast enough.
- Severe infection.
- Problems with blood chemistry.
- Low amounts of red blood cells due to loss of blood or abnormally shaped red blood cells (sickle cell anemia).
- A red blood cell disease that increases red blood cell production (polycythemia).
- Toxic effects of drugs.
What are the benefits of an exchange transfusion?
An exchange transfusion can be a lifesaving procedure. It can prevent your baby from having serious health problems that would otherwise occur because of his or her condition.
What are the risks of an exchange transfusion?
Generally, this is a safe procedure. However, problems may occur, including:
- Infection.
- Bleeding.
- Allergic reactions to medicines.
- Damage to other structures or organs.
- Low blood sugar.
- Problems with blood clotting.
- Unstable blood pressure.
- Breathing problems.
- Unstable mineral (electrolyte) levels in the blood.
What happens during an exchange transfusion?
- All feedings will be stopped as soon as the decision to perform the procedure is made.
- Your baby’s stomach may be emptied using a flexible tube that is passed through the nose or mouth and into the stomach (nasogastric tube).
- Adult donor blood or plasma will be compared to your blood and your baby’s blood. This ensures that your baby’s body will accept the donor blood.
- Your baby may be placed under warming lamps and covered with germ-free (sterile) towels. Only the health care provider may be in the room with your baby. This ensures a safe, clean area for the procedure.
- Your
baby will be connected to machines that will monitor:
- Blood pressure.
- Pulse.
- Breathing rate.
- Your baby may be placed under warming lamps and covered with germ-free (sterile) towels. Only the health care provider may be in the room with your baby. This ensures a safe, clean area for the procedure.
- Flexible tubes (catheters) will be inserted into your baby’s blood vessels. The catheters are usually passed through the belly button. One catheter will be inserted into a blood vessel that carries blood away from the heart (artery). Another catheter will be inserted into a blood vessel that carries blood to the heart (vein).
- A small amount of your baby’s blood will be removed and replaced with donor blood or plasma. This is done slowly, over a few minutes. This process is repeated every few minutes for up to 2 hours. The length of time varies depending on your baby’s condition
- In the NICU, your baby will have blood tests done. Blood tests may be repeated every hour for several hours. Catheters will be kept in place until your baby’s blood test results are normal. Your baby may be fed starting 2–4 hours after the exchange transfusion ends.
What happens after an exchange transfusion?
After the exchange transfusion is complete, your baby will be monitored in the neonatal intensive care unit (NICU). The length of time spent in the NICU varies depending on your baby’s condition.
In the NICU, your baby will have blood tests done. Blood tests may be repeated every hour for several hours. Catheters will be kept in place until your baby’s blood test results are normal. Your baby may be fed starting 2–4 hours after the exchange transfusion ends.
