“When the going gets tough, the tough get going…” When phototherapy fails, you know that you got blood to the rescue! Neonates and preterms have issues like increased bilirubin and hemolytic disease of new born (HDFN) as we know. Sometimes, when the bilirubin is overly elevated or the more easier phototherapy is ineffective, exchange transfusion (ET) is preferred.
Don’t be alarmed yet! The concept is to remove the baby’s blood and replace it with healthy fresh donor blood. That way, we can i)correct the anaemia & remove bilirubin and ii)remove all the unwanted mother’s antibody killing the baby’s RBCs. All this happens while maintaining blood volume in the baby, so only small aliquots of blood are involved at a time. Most preferably we go for double volume ET as it can replace upto 85 percent of the blood volume. Also remember, it is done to prevent or stop the progress of kernicterus which is brain damage caused due to high bilirubin levels.
Freshly bled O Neg compatible blood with a good hematocrit is chosen, leucodepleted, irradiated, negative for CMV and maternal antibodies. AB Plasma is used along with PRBC to dilute the blood and maintain hemodynamics. After securing the umbilical venous catheter carefully, push pull method is used to push donor PRBC, FFP simultaneously while pulling the baby’s blood out. This procedure needs skills of the highest order and undivided attention for at least 2 hrs by the pediatrician, even a tiny lapse in concentration can have devastating outcomes given each drop of blood is accounted for in a newborn😌
Here in this pic, we see the super awesome Dr.Naimisha, Dr.Srinivas and Dr.Vishwanath (previous post) at the best of their craft doing what they love doing the best! You guys are as awesome as the gift of life, blood, together saving lives, a formidable team!