Book of Medical Disorders in Pregnancy - Tintash

transfused at a time to prevent over
loading and cardiac embarrassment.
Fresh albumin can also bind bilirubin
that is liberated as a result of subsequent
hemolysis. The volume of blood
required for a seven pound baby is about
500 mL. Three, and sometimes more,
exchange transfusions are usually
needed.
Pre requisites for exchange
transfusions:
Severe anemia (Hb < 10 g/dl), rate of
bilirubin rises more than .5 mg/dl despite
optimal phototherapy, hyper-bilirubinemia
and DAT.
Objectives: Decrease serum bilirubin
and prevent kernicterus, provide compatible
red cells to provide oxygen carrying
capacity, decrease amount of incompatible
antibody and remove fetal
antibody coated red cell.
Donor blood
Waste blood
Fig 9.3: Showing exchange transfusion
under process
Potential complications of exchange
transfusion: Cardiac arrhythmia,
volume overload, congestive failure and
arrest. Hematologic over heparinization,
neutropenia, thrombocytopenia and graft
versus host disease. Infectious bacterial,
132
viral (CMV, HIV, hepatitis) and
malarial. Metabolic acidosis, hypocalcemia,
hypoglycemia, hyperkalemia hypernatremia.
Vascular Embolization, thrombosis,
necrotizing enterocolitis, and
perforation of umbilical vessel and
systemic hypothermia.
Reserve albumin binding capacity - It
has been reported that when the reserve
albumin binding capacity is 50 per cent
of normal, jaundiced infants can escape
brain damage even when the serum
indirect bilirubin concentration is as high
as 30 mg. per 100 mi. Unfortunately
there is no way of being sure that in
which neonate and at what critical value
of bilirubin in the serum the brain
damage will occur. Kernicterus is
preventable by exchange transfusion.
The higher bilirubin levels still have
some statistical validity in causing brain
damage therefore the levels should be
followed closely, and repeated exchange
transfusions should be done to control
high and increasing bilirubin
concentrations.
Follow up: TSB that needs photo
therapy should mandate an investigation
for cause. History, physical examination,
lab tests, etc. etc.
Recommendation: Adequate follow up
should be ensured for all infants who are
jaun-diced. Infants under phototherapy
should be investigated for determination
of the cause of jaundice. Prior to the
discharge of every newborn, there should
be a process and protocol in place
for assessing the risk for development of
significant hyperbilirubinemia in all
newborns nurseries. There should be a
systematic approach to the assessment of
all infants before discharge for this risk
and program and follow up should be in