Exchange transfusion

Overview

Technically, "exchange transfusion" can refer to any blood product, but typically Involves removing patient's RBCs and replacing with donor RBCs
- When treating neonatal polycythemia, RBCs are replaced with normal saline, albumin, or plasma rather than donor RBCs
In contrast to simple transfusion, avoids hyperviscosity and volume overload
Erythrocytapheresis: involves separating out patients RBCs from other blood components extracorporeally in a centrifuge, then returning the rest of the patient's blood to them with the donor RBCs

Severe complications of sickle cell disease
- Stroke
- Acute chest syndrome (reserved for severe cases)
- Priapism (conflicting evidence for benefit)
- Other complications requiring transfusion when Hb >10
Toxicities
- Sulfhemoglobinemia, severe
- Methemoglobinemia in patients with G6PD or with methemoglobinemia due to nitrite treatment of cyanide
- Severe hemolysis due to formic acid toxicity
Severe hemolysis due to malaria or babesiosis
Neonatal hyperbilirubinemia, extremely severe or unresponsive to phototherapy

Supplies for vascular access
Packed RBCs for transfusion
Apheresis centrifuge (and any associated supplies) if planning erythrocytapheresis

Place at least two peripheral IVs
Next steps dependent on whether blood will be exchanged via apheresis
If no apheresis machine available:
- Slowly remove 5-20mL of patient's blood
- Replace phlebotomized blood with warmed RBCs (or saline/albumin/plasma) in equal or greater amounts
- Repeat prior steps until desired amount transfused

[[Category:Heme/Onc